Prone Lateral Minimally Invasive Retropleural Corpectomy Using a Rotatable Radiolucent Jackson Table

Recently, a single position to approach surgery has gained attention for its ability to enhance operating room efficiency. Here, we propose a prone lateral surgical technique by utilizing a rotatable Jackson table. Spinal surgeons can easily shift from the lateral approach to the posterior approach by rotating the Jackson table without a need for redraping or repositioning the patient. The interlateral approaches to a thoracic spine can be performed via either a transpleural approach or a retropleural approach. Typically, one-lung ventilation and pleural violation were needed while performing a transpleural approach. And this increases the risk of pulmonary complications such as pleural effusion and pneumonia. Combining these two concepts, prone lateral retropleural approach using a rotatable Jackson table, offers certain major advantages, including minimal pleural invasion, enhanced operating room efficiency, and the familiarity for the surgeon to perform posterior procedures in the prone position.

[Narrator] To begin, place pads on the Jackson table, ensuring they do not obstruct the surgical field for a retropleural approach. Using the Mizuho Jackson Modular Table System, position the patient prone after the induction of general anesthesia. Apply tape to the legs, arms, and head For additional stabilization. Carefully tape the head to the table, ensuring it remains cushioned and free from excess tension during rotation. Once the patient is fully secured, manually rotate the patient 30 to 40 degrees away from the surgical approach side. For thoracic or thoracolumbar spine procedures, rotate approximately 30 degrees. In the rotated prone position, make a skin incision. Perform a circumferential subperiosteal dissection of the rib as dorsally as possible. Using a rib cutter and rongeur, resect part of the rib after detaching it from the subcostal neurovascular bundle and parietal pleura. Develop the retropleural space by gently separating the endothoracic fascia from the parietal pleura. Carefully perform a blunt dissection above and below the target disc to minimize parietal pleura injury. After developing the retropleural space, dock a table-mounted oblique lateral interbody fusion retractor to retract the parietal pleura ventrally. After fully exposing the surgical corridor, perform annulotomies at the discs above and below the target vertebral body using a scalpel. Then use a disc shaver and rongeur to carry out discectomy at both levels. Carefully remove the targeted vertebral body using an osteotome, rongeur, and high-speed burr. Under a surgical microscope, perform direct decompression and cut the anterior longitudinal ligament if significant angular realignment is necessary. To test for pleural integrity, fill the surgical wound with sterile water using a syringe while maintaining the patient in the 30-degree rotated prone position. Begin Ambu bag ventilation. Observe for air bubbles on the water's surface, which would indicate a visceral pleura breach requiring chest tube insertion. After completing the air leak test, rotate the table back to a horizontal position without changing the surgical drapes. 27 consecutive patients underwent single-position prone lateral retropleural corpectomy. This cohort was compared to 54 patients who underwent a conventional two-stage transpleural approach corpectomy in the decubitus position combined with a posterior approach in the prone position. Compared to the transpleural group, the retropleural group showed significantly lower values in chest tube placement, postoperative drainage duration, hospital stay length, costophrenic angle blunting, pneumonia requiring antibiotic treatment, and corpectomy number. Compared to the transpleural group, the retropleural group had significantly higher values in the rate of single-session anterior and posterior procedures, and the degree of kyphosis correction.