Trap-door rib-head osteotomies for posterior placement of expandable cages after transpedicular corpectomy: an alternative to lateral extracavitary and costotransversectomy approaches.

Lateral extracavitary and costotransversectomy approaches have been well described, and they are useful for posterior thoracic corpectomies. However, these approaches require pleural dissection and are associated with welldocumented morbidities, including hemothorax, pneumothorax, and pneumonia. But without removing the rib head, the window through which an expandable cage can be placed from a posterior approach is narrow. Thus, smaller nonexpandable mesh cages or methylmethacrylate constructs are commonly used for anterior column reconstruction. The authors describe a technique of using a "trap-door" rib-head osteotomy that avoids pleural dissection, yet allows a large expandable cage to be placed from an entirely posterior approach.