Prone lateral thoracolumbar corpectomy: Case series and technique description

Prone lateral thoracolumbar corpectomy: Case series and technique description | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Prone lateral thoracolumbar corpectomy: Case series and technique description John Kleinmeyer, Gabriel Pokorny, Colton Giorgi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7321793/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract Introduction: Thoracolumbar corpectomies are essential for managing anterior spinal column pathologies, including tumor, trauma, infection, and deformity. While traditional open approaches may cause significant morbidity, minimally invasive lateral retroperitoneal and retropleural techniques have reduced this burden and are associated with fewer complications. However, these approaches are typically performed in the lateral decubitus position, limiting posterior access and requiring patient repositioning. The adoption of prone positioning for lateral access enables single-position anterior and posterior column procedures, enhancing surgical efficiency and reducing morbidity. This case series describes a novel, dedicated prone lateral thoracolumbar corpectomy technique and presents four illustrative cases to highlight its procedural benefits and potential advantages over repurposed systems . Cases Description: Four cases are described in the present study involving different pathologies and thoracolumbar spine regions highlighting the flexibility of the procedure. Case one describes the treatment of a T12-L1 spondylodiscitis, while case 2 showcases the use of prone corpectomy to treat a T10-T12 failed instrumentation with fracture pseudarthrosis and kyphosis. Finally, both cases 3 and 4 describe the treatment of tumors, in the lumbar (L3) and thoracolumbar (T12) regions, respectively. Conclusion: The present case series reports four cases of prone lateral thoracolumbar corpectomy using a dedicated retractor system. This approach remains safe and effective in management of diverse spinal pathologies. The technique allows for robust anterior column reconstruction, control of alignment, and efficient single-position surgery avoiding repositioning. While early results are promising, larger studies are needed to validate its long-term outcomes and compare its benefits to traditional approaches. Spinal Corpectomy Prone trans-psoas Retro-peritoneal Tumor Fracture Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Thoracolumbar corpectomies are effective and powerful options for management of the anterior column in spinal pathologies as varied as tumor, trauma, infection and deformity [ 1 , 2 ]. Retroperitoneal and retropleural access for corpectomy is challenging, given the confluence of complex local anatomy and severe or disruptive pathologies, and the risk of complications is a significant concern. Traditionally performed via open posterior or radical anterior approaches, these procedures often required extensive dissection of paraspinal musculature and pleural or peritoneal manipulation, resulting in significant morbidity and complication rates. The evolution of minimally invasive techniques has markedly reduced the risks of thoacolumbar corpectomies [ 3 , 4 ]. Among these, less invasive lateral retroperitoneal and retropleural approaches with retractors designed for transpsaoas lateral access have been increasingly favored. These approaches offer broad exposure to the vertebral body and disc space and enabling the placement of larger interbody cages with improved endplate coverage [ 5 – 7 ]. However, these techniques are typically performed with the patient in the lateral decubitus position, which limits access to the posterior column. As a result, repositioning is often required for posterior decompression, instrumentation, or osteotomies, increasing operative time and morbidity while reducing surgical efficiency [ 8 , 9 ]. The introduction and increased adoption of prone positioning for lateral interbody access [ 10 , 11 ] has led to reports of lateral thoracolumbar corpectomies in the prone position. Prone positioning allows for single-position simultaneous access to the anterior and posterior columns, deformity correction and reestablishment of lordosis, direct decompression, placement and revision of instrumentation, and further obviates the need to reposition for workflow management (e.g. anterior-posterior or posterior-anterior-posterior cases) [ 9 , 12 ]. This is particularly advantageous at the thoracolumbar junction, where the neurovascular and diaphragm may limit access and robust segmental control is critical, or for critical bone loss in tumor or infection. While early reports have demonstrated the safety and potential advantages of prone transpsoas corpectomies, they often rely on approaches and retractor systems repurposed from degenerative interbody procedures[ 12 , 13 ]. The role of a retractor system specifically engineered for prone lateral corpectomy and the potential for improved access, rigidity, and efficiency in both the thoracic and lumbar spine has not yet been evaluated. This case series presents a dedicated prone lateral thoracolumbar corpectomy technique, highlighting four illustrative cases that underscore the theoretical advantages and procedural consideration of this evolving approach. Surgical Description The patient is positioned prone on coronally rotating chest and hip pads (Alphatec Spine, Inc., Carlsbad, CA). A coronal bend is placed to gently tension the lateral skin on the approach side. The legs are positioned neutrally or in gentle extension and may be rotated away from the approach side if this assists exposure. The lateral chest pad adjacent to the approach may be removed to allow preparation and access to the thoracic spine. Neuromonitoring leads are placed for triggered electromyography and somatosensory evoked potentials during transpsoas access. The patient is prepared and draped for both posterior and lateral access. Bilateral lateral access is possible if needed to address specific pathology. If planned prior to lateral access, a posterior approach and associated procedures are completed. Exposure may be maintained for simultaneous access to the anterior and posterior spine. The lateral approach may then be completed while seated, or standing with the operative table elevated and rotated away from the surgeon. The disc segments above and below the planned corpectomy segments are identified and marked at the skin laterally based on lateral fluoroscopy or intraoperative navigation. A retropleural approach is favored for low thoracic segments to T11, and a retroperitoneal approach is favored for L2-4. Approaches from T12-L1 are chosen based on local anatomy and the position of the diaphragm and associated structures. An oblique incision is made, and deep dissection is completed in line with the spine. Retroperitoneal access is obtained by bluntly splitting the external and internal oblique muscles in line with their fibers, then dissecting the transversalis fascia. The peritoneum is manually elevated from the retroperitoneum and psoas, with care taken to avoid disrupting retroperitoneal adipose cranial or caudal to the planned exposure to avoid creep. Retropleural access is obtained by blunt dissection to the rib overlying the targeted level. The tissue and neurovascular bundle are dissected free and protected, and the endothoracic fascia with the parietal pleura is bluntly dissected from the chest wall. Dissection is directed posteriorly in line with the planned exposure. A lateral and posterior portion of the rib overlying the corpectomy segment is resected, leaving a smooth edge of remaining bone. Peritoneal or pleural defects are repaired if they occur. Pleural defects are closed over a drain, which is either pulled with closure after elimination of pneumothorax or left if needed for surgical site drainage. If a wider anterior exposure is needed or the pleura or peritoneum is adhered due to the underlying pathology, handheld retractors, Kittners and other blunt instruments allow meticulous dissection. The psoas fascia or lateral spine is then directly visualized prior to dilator placement. A dilator is then positioned with navigation or lateral fluoroscopy at the disc if discectomy is planned first, or at the corpectomy segment if discectomy is not relevant. Neuromonitoring is utilized with triggered electromyography for dilator placement and sequential dilation at levels with a present psoas, and prior to bone or disc excision at all levels. Somatosensory evoked potentials are utilized at all levels, and motor evoked potentials are utilized at cord levels or when relevant to the procedure. A long-throw, specifically engineered corpectomy retractor (Alphatech Spine, Inc.) is then placed. A rectangular retractor is placed at levels above the psoas. An oval retractor is placed for transpsoas access or when appropriate for the anatomy. Cranial-caudal or anterior-posterior retractor blade orientation is chosen based on anatomy and pathology. Accessory blades can be placed, and the retractor position can be maintained with shims, fixation pins, and blade extensions. Anterior exposure can be obtained with direct dissection when needed. Posterior dissection can expose the rib head or pedicle, allowing subsequent exposure of the canal, with care taken with the posterior psoas and lumbar plexus. Simultaneous posterior and anterolateral exposures can allow circumferential exposure of the canal. The corpectomy is then completed. While a reproducible and generalizable technique for prone lateral thoracolumbar corpectomies is essential to safe access and management, individual patient and anatomic factors may require alterations in workflow. Case Presentations All patients included in the present case-series provided informed consent for having their deidentified data collected for retrospective review with institutional review board approval. Patient 1 (T12-L1 spondylodiscitis): A 66-year-old female presented with progression of T12-L1 spondylodiscitis ( bacillus spp.) despite the use of antibiotics and other nonsurgical treatment (Fig. 1 A‒B). She had progression of right lower extremity weakness. Surgery was recommended. She underwent prone lateral retropleural corpectomies, complete L1 and partial T12, with limited posterior decompression and percutaneous instrumented fusion from T11-L2 (Fig. 1 C-E). Surgery duration was 303 minutes, with a retractor time of 45 minutes and an estimated blood loss of 700 ml. The patient was ambulatory by the second postoperative day and was discharged to a skilled nursing facility on the third postoperative day. Postoperative radiographs found improved coronal and sagittal alignment and healing with construct stability (Fig. 1 F-G). No intraoperative or postoperative complications occurred by the last follow-up visit at 1 year. Patient 2 (Failed T10-L2 posterior instrumentation with kyphosis): A 66-year-old female with a distant T12 osteoporotic burst fracture managed with instrumented presented with progressive back pain, weakness and gait instability. Imaging confirmed pseudoarthrosis and kyphosis, with screw pullout and stenosis (Fig. 2 A-C). She underwent a prone lateral retropleural corpectomy at T12, lateral lumbar interbody fusion at L1-2, and revision posterior fixation from T9-L2 with posterior column osteotomies and revision decompression (Fig. 2 D‒G). The kyphotic deformity was sequentially corrected with combined anterior and posterior approaches. Surgery duration was 274 minutes, with a retractor time of 45 minutes and an estimated blood loss of 500 ml. The patient was ambulatory by the second postoperative day and was discharged at home on the fifth hospitalization day. Postoperative radiographs revealed significant improvement in sagittal alignment (Fig. 2 H-I). No intraoperative or postoperative complications occurred at 6 months of follow up. Patient 3 (L3 tumor): A 42-year-old female presented with intractable low back and right anterior thigh pain. Local imaging found an isolated lytic lesion of L3, and staging and biopsy confirmed an isolated breast adenocarcinoma metastasis at L3 (Fig. 3 A-B). She underwent prone transpsoas corpectomy at L3, with an instrumented posterior fusion L2-L4 (Fig. 3 C‒F). The surgery duration was 192 minutes, with an intrapsoas retractor time of 30 minutes and an estimated blood loss of 600 ml. The patient was ambulatory on the day of surgery and was discharged home on the third postoperative day. Postoperative radiographs found reconstruction with stable alignment (Fig. 1 G-H). No intraoperative or postoperative complications occurred at 15 months of follow. Patient 4 (T12 tumor): A 61-year-old woman presented with acute back pain while lifting furniture. Imaging demonstrated a T12 pathologic fracture with lysis. The patient underwent a CT-guided biopsy, consistent with a low-grade chrondrosarcoma. She then underwent a prone retroperitoneal spondylectomy, with instrumentation from T10-L1. The segment was mobilized posteriorly and subsequently delivered through the lateral approach. Surgical duration was 281 minutes, with an intrapsoas retractor time of 45 minutes and an estimated blood loss of 100 cc. The patient was ambulatory on the day of surgery, and was discharged home on the second postoperative day. Upright radiographs demonstrated appropriate alignment and complete T12 spondylectomy. Pathology confirmed chondrosarcoma without extension, and further chemoradiotherapy was deferred. Discussion We present a series of four patients undergoing prone lateral thoracolumbar corpectomies. Compared with traditional corpectomy techniques, lateral corpectomy offers a minimally invasive alternative with potential for substantial correction and access to both columns with a lower risk profile [ 4 ]. The prone lateral approach, while increasingly adopted for degenerative conditions, has only recently been evaluated for corpectomies [ 9 , 14 ]. The present study includes 4 cases for a variety of conditions and describes a surgical technique for lateral retropleural and retroperitoneal thoracolumbar corpectomies in a prone position, using a purpose-built retractor system. Less invasive lateral retroperitoneal and retropleural access improves safety, efficiency and reproducibility of thoracolumbar corpectomies in treatment of complex spinal pathology from the lower thoracic spine to L4. The approach enables placement of wide, tall cages that restore anterior column support and enhance construct stability. Wipplinger et al. (2022) reported in their systematic review that, compared with posterolateral approaches, anterolateral approaches are associated with lower complication and revision rates [ 3 ]. Similarly, Spiessberger et al. (2020), in a systematic review comparing seven different techniques for thoracolumbar corpectomies spinal metastases, reported that compared with other traditionally employed approaches retropleural and retroperitoneal approaches, together with thoracoscopic approaches, led to significant reductions in blood loss, surgical duration and complications[ 4 ]. Despite growing interest, literature on prone lateral corpectomy remains limited. Gandhi et al. (2021) described two successful cases with combined anterior and posterior access and favorable outcomes[ 13 ]. Stone et al.(2022) reported a case of corpectomy performed in a prone position while providing a brief technical description and detailed discussion of the selected approach[ 12 ]. Finally, in a recent publication, Guiroy et al (2023), published the first comparison of prone and lateral corpectomies, reporting similar profiles and rates of complications and surgical outcomes, but longer surgical times with the prone position. Additionally, the authors found that the prone approach led to improved lordosis, though the difference was not statistically significant[ 9 ]. In the current series, the prone position allowed safe and efficient access to the planned corpectomy segment via retropleural or retroperitoneal approaches. The exposure can be tailored to the pathology and supplemented with a simultaneous posterior approach. In comparison to lateral decubitus or supine positioning, the prone position allows decompression, deformity correction, and both anterior and posterior stabilization in a single position without need for repositioning. This is particularly appropriate for more complex procedures requiring debridement of infection or tumor, or single position spondylectomy preserving the neuroelements. Conclusion The present case series reports four cases of prone lateral thoracolumbar corpectomy using a dedicated retractor system. This approach remains safe and effective in the management of diverse spinal pathologies. The technique allows for robust anterior column reconstruction, control of alignment, and enables efficient single-position surgery. While early results are promising, larger studies are needed to validate its long-term outcomes and compare its benefits to traditional approaches. Declarations Funding No funding was received for this study. Availability of data and materials No data are available online; however, under reasonable request, the data can be shared by the author. Authors roles JK (study conception, data curation, writing-original draft, reviewing final draft) GP (writing the final draft, reviewing the final draft, visualization) CG (study conception, reviewing final draft) Clinical Trial Number: Not Applicable Ethical Approval: This is an case-series study. The Research Ethics Committee has confirmed that no ethical approval is required. However, all patients provided explicitly authorization for the use of their de-identified data by filling and free-consent form. Consent to participate: Informed consent was obtained from all individual participants included in the study. Author Contribution JK (study conception, data curation, writing-original draft, reviewing final draft)GP (writing the final draft, reviewing the final draft, visualization)CG (study conception, reviewing final draft) References Podet AG, Morrow KD, Robichaux JM, Shields JA, Digiorgio AM, Tender GC (2020) Minimally invasive lateral corpectomy for thoracolumbar traumatic burst fractures. Neurosurg Focus 49:1–9 Wewel JT, Uribe JS (2020) Retropleural Thoracic Approach. Neurosurg Clin N Am 31:43–48 Wipplinger C, Lener S, Orban C, Wipplinger TM, Abramovic A, Lang A, Hartmann S, Thomé C (2022) Technical nuances and approach-related morbidity of anterolateral and posterolateral lumbar corpectomy approaches-a systematic review of the literature. Acta Neurochir (Wien) 164:2243–2256 Spiessberger A, Arvind V, Gruter B, Cho SK (2020) Thoracolumbar corpectomy/spondylectomy for spinal metastasis: a pooled analysis comparing the outcome of seven different surgical approaches. European Spine Journal 29:248–256 Christiansen PA, Huang S, Smith JS, Shaffrey ME, Uribe JS, Yen CP (2020) Mini-open lateral retropleural/retroperitoneal approaches for thoracic and thoracolumbar junction anterior column pathologies. Neurosurg Focus 49:1–8 Uribe JS, Katsevman GA, Morgan CD, Paisan GM, Snyder LA (2022) Mini-open lateral retropleural thoracic discectomy approach. Neurosurgical focus: Video 7:V2 Amaral R, Marchi L, Oliveira L, Coutinho T, Pimenta L (2013) Acute lumbar burst fracture treated by minimally invasive lateral corpectomy. Case Rep Orthop 2013: Amaral R, Daher MT, Pratali R, Arnoni D, Pokorny G, Rodrigues R, Batista M, Fortuna PP, Pimenta L, Fernando P S Herrero C (2021) THE EFFECT OF PATIENT POSITION ON PSOAS MORPHOLOGY AND IN LUMBAR LORDOSIS. World Neurosurg. https://doi.org/10.1016/j.wneu.2021.06.067 Guiroy A, Thomas JA, Bodon G, et al (2023) Single-Position Transpsoas Corpectomy and Posterior Instrumentation in the Thoracolumbar Spine for Different Clinical Scenarios. Oper Neurosurg (Hagerstown) 24:310–317 Pimenta L, Taylor WR, Stone LE, Wali AR, Santiago-Dieppa DR (2020) Prone transpsoas technique for simultaneous single position access to the anterior and posterior spine. Oper Neurosurg Drossopoulos PN, Bardeesi A, Wang TY, et al (2024) Advancing Prone-Transpsoas Spine Surgery: A Narrative Review and Evolution of Indications with Representative Cases. Journal of Clinical Medicine 2024, Vol 13, Page 1112 13:1112 Stone LE, Diaz-Aguilar LD, Santiago-Dieppa DR, Taylor WR, Nguyen AD (2022) Prone-lateral access to the lumbar spine: single-level corpectomy with approach discussion. Neurosurgical Focus: Video 7:V9 Gandhi SD, Liu DS, Sheha ED, Colman MW (2021) Prone transpsoas lumbar corpectomy: simultaneous posterior and lateral lumbar access for difficult clinical scenarios. J Neurosurg Spine 35:284–291 White MD, Uribe JS (2023) Transpsoas Approaches to the Lumbar Spine: Lateral and Prone. Neurosurg Clin N Am 34:609–617 Additional Declarations Competing interest reported. JK and GP receives consultancy fees from ATEC CG is an employee from ATEC Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 04 Nov, 2025 Reviews received at journal 22 Oct, 2025 Reviews received at journal 16 Oct, 2025 Reviewers agreed at journal 16 Oct, 2025 Reviewers agreed at journal 14 Oct, 2025 Reviews received at journal 30 Sep, 2025 Reviewers agreed at journal 09 Sep, 2025 Reviewers invited by journal 14 Aug, 2025 Editor assigned by journal 12 Aug, 2025 Submission checks completed at journal 12 Aug, 2025 First submitted to journal 07 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":659150,"visible":true,"origin":"","legend":"\u003cp\u003eA-B: Sagittal and axial T1 contrasted sequences at presentation and subsequent follow-up demonstrating progressive lysis and abscess formation at L1 greater than T12 with kyphosis and intraosseous and peridiscal edema. C-E: Intraoperative fluoroscopy with initial dilator placement at the T12–L1 disc space and defect via a retropleural approach following posterior decompression and instrumentation. A rectangular corpectomy retractor was placed with blades in a cranial and caudal orientation, and the accessory blade was placed anteriorly. L1 and partial T12 corpectomies were completed. An expandable corpectomy cage was placed following thorough debridement and irrigation prior to the completion of posterior instrumentation with decompression. G-H: Long AP and lateral radiographs.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7321793/v1/04e02a129c1445a9c143aa3e.png"},{"id":93370538,"identity":"c291adc9-c5b6-4ff2-826b-f853c852c970","added_by":"auto","created_at":"2025-10-13 06:27:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":477981,"visible":true,"origin":"","legend":"\u003cp\u003eA-C: Lateral radiograph with a T12 burst fracture and T10-L2 instrumentation with pull out. Sagittal and axial CT revealed T12 nonunion and an intraosseous vacuum and cleft. T2 and STIR sagittal MR images revealed T12 nonunion, cleft with fluid, and stenosis. E-G: Intraoperative fluoroscopy following posterior revision instrumentation, decompression, and posterior column osteotomies demonstrating initial docking at T12. A rectangular corpectomy retractor was placed with blades in an anterior and posterior orientation, with accessory blades. An expandable corpectomy cage was placed into the defect. H-I: Long AP and lateral radiographs showing significant correction of sagittal alignment and maintenance of coronal alignment.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7321793/v1/5656383ba36a8c4f66b6560d.png"},{"id":93370539,"identity":"165f21ec-6689-482d-a830-ae7fd3868a9a","added_by":"auto","created_at":"2025-10-13 06:27:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":455871,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA-B:. \u003c/strong\u003eSagittal and axial T1-weighted MR images and T2-weighted MR images of a right L3 lytic lesion and pathologic fracture, with impingement of the exiting L3 nerve root. \u003cstrong\u003eC-F: \u003c/strong\u003eIntraoperative fluoroscopy following posterior transpedicular decompression demonstrating initial docking at the L3-4 (lateral) and L2--3 (AP) disc spaces, completing discectomies with release of the annulus. An oval corpectomy retractor was placed with blades in a cranial and caudal orientation, with accessory anterior and posterior blades. A partial spondylectomy was completed, and an expandable corpectomy cage was placed in the defect. \u003cstrong\u003eG-H\u003c/strong\u003e: AP and lateral radiographs with partial spondylectomy and reconstruction.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7321793/v1/665f13e4a5e682fa98c10fde.png"},{"id":93370543,"identity":"7453b218-61fe-4925-9b35-e5a0870b7c98","added_by":"auto","created_at":"2025-10-13 06:27:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":744588,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA-E: \u003c/strong\u003eSagittal and axial T1-weighted MR images and T2-weighted MR images of a right T12 lytic lesion and pathologic fracture. \u003cstrong\u003eF-H: \u003c/strong\u003eCT scan images in both sagittal and axial plane showing the lytic lesion in the T12 vertebral body. \u003cstrong\u003eI-K: \u003c/strong\u003eIntraoperative fluoroscopy following posterior decompression demonstrating initial docking at T12 and posterior fixation from T10-L1. \u003cstrong\u003eL-M\u003c/strong\u003e: AP and lateral radiographs showing achievement of excellent sagittal and coronal alignment.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7321793/v1/850c22b1d50f637c9ea56822.png"},{"id":93371819,"identity":"51c6b151-d75f-4114-a3a4-d9ff4fa2d7f6","added_by":"auto","created_at":"2025-10-13 06:51:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3140137,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7321793/v1/2b9c85c5-726a-4d12-89a1-33db7fd11a7c.pdf"}],"financialInterests":"Competing interest reported. JK and GP receives consultancy fees from ATEC\nCG is an employee from ATEC","formattedTitle":"Prone lateral thoracolumbar corpectomy: Case series and technique description","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThoracolumbar corpectomies are effective and powerful options for management of the anterior column in spinal pathologies as varied as tumor, trauma, infection and deformity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Retroperitoneal and retropleural access for corpectomy is challenging, given the confluence of complex local anatomy and severe or disruptive pathologies, and the risk of complications is a significant concern.\u003c/p\u003e\u003cp\u003eTraditionally performed via open posterior or radical anterior approaches, these procedures often required extensive dissection of paraspinal musculature and pleural or peritoneal manipulation, resulting in significant morbidity and complication rates. The evolution of minimally invasive techniques has markedly reduced the risks of thoacolumbar corpectomies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Among these, less invasive lateral retroperitoneal and retropleural approaches with retractors designed for transpsaoas lateral access have been increasingly favored. These approaches offer broad exposure to the vertebral body and disc space and enabling the placement of larger interbody cages with improved endplate coverage [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, these techniques are typically performed with the patient in the lateral decubitus position, which limits access to the posterior column. As a result, repositioning is often required for posterior decompression, instrumentation, or osteotomies, increasing operative time and morbidity while reducing surgical efficiency [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe introduction and increased adoption of prone positioning for lateral interbody access [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] has led to reports of lateral thoracolumbar corpectomies in the prone position. Prone positioning allows for single-position simultaneous access to the anterior and posterior columns, deformity correction and reestablishment of lordosis, direct decompression, placement and revision of instrumentation, and further obviates the need to reposition for workflow management (e.g. anterior-posterior or posterior-anterior-posterior cases) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This is particularly advantageous at the thoracolumbar junction, where the neurovascular and diaphragm may limit access and robust segmental control is critical, or for critical bone loss in tumor or infection.\u003c/p\u003e\u003cp\u003eWhile early reports have demonstrated the safety and potential advantages of prone transpsoas corpectomies, they often rely on approaches and retractor systems repurposed from degenerative interbody procedures[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The role of a retractor system specifically engineered for prone lateral corpectomy and the potential for improved access, rigidity, and efficiency in both the thoracic and lumbar spine has not yet been evaluated.\u003c/p\u003e\u003cp\u003eThis case series presents a dedicated prone lateral thoracolumbar corpectomy technique, highlighting four illustrative cases that underscore the theoretical advantages and procedural consideration of this evolving approach.\u003c/p\u003e"},{"header":"Surgical Description","content":"\u003cp\u003eThe patient is positioned prone on coronally rotating chest and hip pads (Alphatec Spine, Inc., Carlsbad, CA). A coronal bend is placed to gently tension the lateral skin on the approach side. The legs are positioned neutrally or in gentle extension and may be rotated away from the approach side if this assists exposure. The lateral chest pad adjacent to the approach may be removed to allow preparation and access to the thoracic spine. Neuromonitoring leads are placed for triggered electromyography and somatosensory evoked potentials during transpsoas access. The patient is prepared and draped for both posterior and lateral access. Bilateral lateral access is possible if needed to address specific pathology.\u003c/p\u003e\u003cp\u003eIf planned prior to lateral access, a posterior approach and associated procedures are completed. Exposure may be maintained for simultaneous access to the anterior and posterior spine. The lateral approach may then be completed while seated, or standing with the operative table elevated and rotated away from the surgeon.\u003c/p\u003e\u003cp\u003eThe disc segments above and below the planned corpectomy segments are identified and marked at the skin laterally based on lateral fluoroscopy or intraoperative navigation. A retropleural approach is favored for low thoracic segments to T11, and a retroperitoneal approach is favored for L2-4. Approaches from T12-L1 are chosen based on local anatomy and the position of the diaphragm and associated structures.\u003c/p\u003e\u003cp\u003eAn oblique incision is made, and deep dissection is completed in line with the spine. Retroperitoneal access is obtained by bluntly splitting the external and internal oblique muscles in line with their fibers, then dissecting the transversalis fascia. The peritoneum is manually elevated from the retroperitoneum and psoas, with care taken to avoid disrupting retroperitoneal adipose cranial or caudal to the planned exposure to avoid creep. Retropleural access is obtained by blunt dissection to the rib overlying the targeted level. The tissue and neurovascular bundle are dissected free and protected, and the endothoracic fascia with the parietal pleura is bluntly dissected from the chest wall. Dissection is directed posteriorly in line with the planned exposure. A lateral and posterior portion of the rib overlying the corpectomy segment is resected, leaving a smooth edge of remaining bone. Peritoneal or pleural defects are repaired if they occur. Pleural defects are closed over a drain, which is either pulled with closure after elimination of pneumothorax or left if needed for surgical site drainage.\u003c/p\u003e\u003cp\u003eIf a wider anterior exposure is needed or the pleura or peritoneum is adhered due to the underlying pathology, handheld retractors, Kittners and other blunt instruments allow meticulous dissection. The psoas fascia or lateral spine is then directly visualized prior to dilator placement.\u003c/p\u003e\u003cp\u003eA dilator is then positioned with navigation or lateral fluoroscopy at the disc if discectomy is planned first, or at the corpectomy segment if discectomy is not relevant. Neuromonitoring is utilized with triggered electromyography for dilator placement and sequential dilation at levels with a present psoas, and prior to bone or disc excision at all levels. Somatosensory evoked potentials are utilized at all levels, and motor evoked potentials are utilized at cord levels or when relevant to the procedure.\u003c/p\u003e\u003cp\u003eA long-throw, specifically engineered corpectomy retractor (Alphatech Spine, Inc.) is then placed. A rectangular retractor is placed at levels above the psoas. An oval retractor is placed for transpsoas access or when appropriate for the anatomy. Cranial-caudal or anterior-posterior retractor blade orientation is chosen based on anatomy and pathology. Accessory blades can be placed, and the retractor position can be maintained with shims, fixation pins, and blade extensions. Anterior exposure can be obtained with direct dissection when needed. Posterior dissection can expose the rib head or pedicle, allowing subsequent exposure of the canal, with care taken with the posterior psoas and lumbar plexus. Simultaneous posterior and anterolateral exposures can allow circumferential exposure of the canal.\u003c/p\u003e\u003cp\u003eThe corpectomy is then completed. While a reproducible and generalizable technique for prone lateral thoracolumbar corpectomies is essential to safe access and management, individual patient and anatomic factors may require alterations in workflow.\u003c/p\u003e"},{"header":"Case Presentations","content":"\u003cp\u003eAll patients included in the present case-series provided informed consent for having their deidentified data collected for retrospective review with institutional review board approval.\u003c/p\u003e\u003ch3\u003ePatient 1 (T12-L1 spondylodiscitis):\u003c/h3\u003e\u003cp\u003eA 66-year-old female presented with progression of T12-L1 spondylodiscitis (\u003cem\u003ebacillus\u003c/em\u003e spp.) despite the use of antibiotics and other nonsurgical treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA‒B). She had progression of right lower extremity weakness. Surgery was recommended. She underwent prone lateral retropleural corpectomies, complete L1 and partial T12, with limited posterior decompression and percutaneous instrumented fusion from T11-L2 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC-E). Surgery duration was 303 minutes, with a retractor time of 45 minutes and an estimated blood loss of 700 ml. The patient was ambulatory by the second postoperative day and was discharged to a skilled nursing facility on the third postoperative day. Postoperative radiographs found improved coronal and sagittal alignment and healing with construct stability (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eF-G). No intraoperative or postoperative complications occurred by the last follow-up visit at 1 year.\u003c/p\u003e\u003ch3\u003ePatient 2 (Failed T10-L2 posterior instrumentation with kyphosis):\u003c/h3\u003e\u003cp\u003eA 66-year-old female with a distant T12 osteoporotic burst fracture managed with instrumented presented with progressive back pain, weakness and gait instability. Imaging confirmed pseudoarthrosis and kyphosis, with screw pullout and stenosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA-C). She underwent a prone lateral retropleural corpectomy at T12, lateral lumbar interbody fusion at L1-2, and revision posterior fixation from T9-L2 with posterior column osteotomies and revision decompression (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD‒G). The kyphotic deformity was sequentially corrected with combined anterior and posterior approaches. Surgery duration was 274 minutes, with a retractor time of 45 minutes and an estimated blood loss of 500 ml. The patient was ambulatory by the second postoperative day and was discharged at home on the fifth hospitalization day. Postoperative radiographs revealed significant improvement in sagittal alignment (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eH-I). No intraoperative or postoperative complications occurred at 6 months of follow up.\u003c/p\u003e\u003ch3\u003ePatient 3 (L3 tumor):\u003c/h3\u003e\u003cp\u003eA 42-year-old female presented with intractable low back and right anterior thigh pain. Local imaging found an isolated lytic lesion of L3, and staging and biopsy confirmed an isolated breast adenocarcinoma metastasis at L3 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA-B). She underwent prone transpsoas corpectomy at L3, with an instrumented posterior fusion L2-L4 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC‒F). The surgery duration was 192 minutes, with an intrapsoas retractor time of 30 minutes and an estimated blood loss of 600 ml. The patient was ambulatory on the day of surgery and was discharged home on the third postoperative day. Postoperative radiographs found reconstruction with stable alignment (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eG-H). No intraoperative or postoperative complications occurred at 15 months of follow.\u003c/p\u003e\u003ch3\u003ePatient 4 (T12 tumor):\u003c/h3\u003e\u003cp\u003eA 61-year-old woman presented with acute back pain while lifting furniture. Imaging demonstrated a T12 pathologic fracture with lysis. The patient underwent a CT-guided biopsy, consistent with a low-grade chrondrosarcoma. She then underwent a prone retroperitoneal spondylectomy, with instrumentation from T10-L1. The segment was mobilized posteriorly and subsequently delivered through the lateral approach. Surgical duration was 281 minutes, with an intrapsoas retractor time of 45 minutes and an estimated blood loss of 100 cc. The patient was ambulatory on the day of surgery, and was discharged home on the second postoperative day. Upright radiographs demonstrated appropriate alignment and complete T12 spondylectomy. Pathology confirmed chondrosarcoma without extension, and further chemoradiotherapy was deferred.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe present a series of four patients undergoing prone lateral thoracolumbar corpectomies. Compared with traditional corpectomy techniques, lateral corpectomy offers a minimally invasive alternative with potential for substantial correction and access to both columns with a lower risk profile [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The prone lateral approach, while increasingly adopted for degenerative conditions, has only recently been evaluated for corpectomies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The present study includes 4 cases for a variety of conditions and describes a surgical technique for lateral retropleural and retroperitoneal thoracolumbar corpectomies in a prone position, using a purpose-built retractor system.\u003c/p\u003e\u003cp\u003eLess invasive lateral retroperitoneal and retropleural access improves safety, efficiency and reproducibility of thoracolumbar corpectomies in treatment of complex spinal pathology from the lower thoracic spine to L4. The approach enables placement of wide, tall cages that restore anterior column support and enhance construct stability. Wipplinger et al. (2022) reported in their systematic review that, compared with posterolateral approaches, anterolateral approaches are associated with lower complication and revision rates [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Similarly, Spiessberger et al. (2020), in a systematic review comparing seven different techniques for thoracolumbar corpectomies spinal metastases, reported that compared with other traditionally employed approaches retropleural and retroperitoneal approaches, together with thoracoscopic approaches, led to significant reductions in blood loss, surgical duration and complications[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite growing interest, literature on prone lateral corpectomy remains limited. Gandhi et al. (2021) described two successful cases with combined anterior and posterior access and favorable outcomes[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Stone et al.(2022) reported a case of corpectomy performed in a prone position while providing a brief technical description and detailed discussion of the selected approach[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFinally, in a recent publication, Guiroy et al (2023), published the first comparison of prone and lateral corpectomies, reporting similar profiles and rates of complications and surgical outcomes, but longer surgical times with the prone position. Additionally, the authors found that the prone approach led to improved lordosis, though the difference was not statistically significant[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the current series, the prone position allowed safe and efficient access to the planned corpectomy segment via retropleural or retroperitoneal approaches. The exposure can be tailored to the pathology and supplemented with a simultaneous posterior approach. In comparison to lateral decubitus or supine positioning, the prone position allows decompression, deformity correction, and both anterior and posterior stabilization in a single position without need for repositioning. This is particularly appropriate for more complex procedures requiring debridement of infection or tumor, or single position spondylectomy preserving the neuroelements.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present case series reports four cases of prone lateral thoracolumbar corpectomy using a dedicated retractor system. This approach remains safe and effective in the management of diverse spinal pathologies. The technique allows for robust anterior column reconstruction, control of alignment, and enables efficient single-position surgery. While early results are promising, larger studies are needed to validate its long-term outcomes and compare its benefits to traditional approaches.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo data are available online; however, under reasonable request, the data can be shared by the author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors roles\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJK (study conception, data curation,\u0026nbsp;writing-original draft, reviewing final draft)\u003c/p\u003e\n\u003cp\u003eGP (writing the final draft, reviewing the final draft, visualization)\u003c/p\u003e\n\u003cp\u003eCG \u0026nbsp;(study conception,\u0026nbsp;reviewing final draft)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eThis is an case-series study. The Research Ethics Committee has confirmed that no ethical approval is required. However, all patients provided explicitly authorization for the use of their de-identified data by filling and free-consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003e\u003cem\u003eInformed consent was obtained from all individual participants included in the study.\u003c/em\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJK (study conception, data curation, writing-original draft, reviewing final draft)GP (writing the final draft, reviewing the final draft, visualization)CG (study conception, reviewing final draft)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePodet AG, Morrow KD, Robichaux JM, Shields JA, Digiorgio AM, Tender GC (2020) Minimally invasive lateral corpectomy for thoracolumbar traumatic burst fractures. Neurosurg Focus 49:1\u0026ndash;9\u003c/li\u003e\n\u003cli\u003eWewel JT, Uribe JS (2020) Retropleural Thoracic Approach. Neurosurg Clin N Am 31:43\u0026ndash;48\u003c/li\u003e\n\u003cli\u003eWipplinger C, Lener S, Orban C, Wipplinger TM, Abramovic A, Lang A, Hartmann S, Thom\u0026eacute; C (2022) Technical nuances and approach-related morbidity of anterolateral and posterolateral lumbar corpectomy approaches-a systematic review of the literature. Acta Neurochir (Wien) 164:2243\u0026ndash;2256\u003c/li\u003e\n\u003cli\u003eSpiessberger A, Arvind V, Gruter B, Cho SK (2020) Thoracolumbar corpectomy/spondylectomy for spinal metastasis: a pooled analysis comparing the outcome of seven different surgical approaches. European Spine Journal 29:248\u0026ndash;256\u003c/li\u003e\n\u003cli\u003eChristiansen PA, Huang S, Smith JS, Shaffrey ME, Uribe JS, Yen CP (2020) Mini-open lateral retropleural/retroperitoneal approaches for thoracic and thoracolumbar junction anterior column pathologies. Neurosurg Focus 49:1\u0026ndash;8\u003c/li\u003e\n\u003cli\u003eUribe JS, Katsevman GA, Morgan CD, Paisan GM, Snyder LA (2022) Mini-open lateral retropleural thoracic discectomy approach. Neurosurgical focus: Video 7:V2\u003c/li\u003e\n\u003cli\u003eAmaral R, Marchi L, Oliveira L, Coutinho T, Pimenta L (2013) Acute lumbar burst fracture treated by minimally invasive lateral corpectomy. Case Rep Orthop 2013:\u003c/li\u003e\n\u003cli\u003eAmaral R, Daher MT, Pratali R, Arnoni D, Pokorny G, Rodrigues R, Batista M, Fortuna PP, Pimenta L, Fernando P S Herrero C (2021) THE EFFECT OF PATIENT POSITION ON PSOAS MORPHOLOGY AND IN LUMBAR LORDOSIS. World Neurosurg. https://doi.org/10.1016/j.wneu.2021.06.067\u003c/li\u003e\n\u003cli\u003eGuiroy A, Thomas JA, Bodon G, et al (2023) Single-Position Transpsoas Corpectomy and Posterior Instrumentation in the Thoracolumbar Spine for Different Clinical Scenarios. Oper Neurosurg (Hagerstown) 24:310\u0026ndash;317\u003c/li\u003e\n\u003cli\u003ePimenta L, Taylor WR, Stone LE, Wali AR, Santiago-Dieppa DR (2020) Prone transpsoas technique for simultaneous single position access to the anterior and posterior spine. Oper Neurosurg \u003c/li\u003e\n\u003cli\u003eDrossopoulos PN, Bardeesi A, Wang TY, et al (2024) Advancing Prone-Transpsoas Spine Surgery: A Narrative Review and Evolution of Indications with Representative Cases. Journal of Clinical Medicine 2024, Vol 13, Page 1112 13:1112\u003c/li\u003e\n\u003cli\u003eStone LE, Diaz-Aguilar LD, Santiago-Dieppa DR, Taylor WR, Nguyen AD (2022) Prone-lateral access to the lumbar spine: single-level corpectomy with approach discussion. Neurosurgical Focus: Video 7:V9\u003c/li\u003e\n\u003cli\u003eGandhi SD, Liu DS, Sheha ED, Colman MW (2021) Prone transpsoas lumbar corpectomy: simultaneous posterior and lateral lumbar access for difficult clinical scenarios. J Neurosurg Spine 35:284\u0026ndash;291\u003c/li\u003e\n\u003cli\u003eWhite MD, Uribe JS (2023) Transpsoas Approaches to the Lumbar Spine: Lateral and Prone. Neurosurg Clin N Am 34:609\u0026ndash;617\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-spine-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"esjo","sideBox":"Learn more about [European Spine Journal](http://link.springer.com/journal/586)","snPcode":"586","submissionUrl":"https://submission.springernature.com/new-submission/586/3","title":"European Spine Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Spinal Corpectomy, Prone trans-psoas, Retro-peritoneal, Tumor, Fracture","lastPublishedDoi":"10.21203/rs.3.rs-7321793/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7321793/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eThoracolumbar corpectomies are essential for managing anterior spinal column pathologies, including tumor, trauma, infection, and deformity. While traditional open approaches may cause significant morbidity, minimally invasive lateral retroperitoneal and retropleural techniques have reduced this burden and are associated with fewer complications. However, these approaches are typically performed in the lateral decubitus position, limiting posterior access and requiring patient repositioning. The adoption of prone positioning for lateral access enables single-position anterior and posterior column procedures, enhancing surgical efficiency and reducing morbidity. This case series describes a novel, dedicated prone lateral thoracolumbar corpectomy technique and presents four illustrative cases to highlight its procedural benefits and potential advantages over repurposed systems\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCases Description: \u003c/strong\u003eFour cases are described in the present study involving different pathologies and thoracolumbar spine regions highlighting the flexibility of the procedure. Case one describes the treatment of a T12-L1 spondylodiscitis, while case 2 showcases the use of prone corpectomy to treat a T10-T12 failed instrumentation with fracture pseudarthrosis and kyphosis. Finally, both cases 3 and 4 describe the treatment of tumors, in the lumbar (L3) and thoracolumbar (T12) regions, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe present case series reports four cases of prone lateral thoracolumbar corpectomy using a dedicated retractor system. This approach remains safe and effective in management of diverse spinal pathologies. \u0026nbsp;The technique allows for robust anterior column reconstruction, control of alignment, and efficient single-position surgery avoiding repositioning. While early results are promising, larger studies are needed to validate its long-term outcomes and compare its benefits to traditional approaches.\u003c/p\u003e","manuscriptTitle":"Prone lateral thoracolumbar corpectomy: Case series and technique description","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-13 06:27:47","doi":"10.21203/rs.3.rs-7321793/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-04T12:45:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-22T22:51:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-16T18:18:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60267370221378451772758291446436557119","date":"2025-10-16T18:08:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"111439663794044220472130490091600313552","date":"2025-10-14T15:07:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T07:30:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220396113450823987273974917427618932378","date":"2025-09-09T15:22:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-14T06:43:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-13T02:16:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-13T02:15:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Spine Journal","date":"2025-08-07T20:25:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-spine-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"esjo","sideBox":"Learn more about [European Spine Journal](http://link.springer.com/journal/586)","snPcode":"586","submissionUrl":"https://submission.springernature.com/new-submission/586/3","title":"European Spine Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4e022d5a-c234-49a4-b5cd-03fa25db661e","owner":[],"postedDate":"October 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2025-11-04T12:53:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-13 06:27:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7321793","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7321793","identity":"rs-7321793","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}