Endoscope-assisted prone lateral retropleural 360° reconstruction of thoracic pathological fracture in metastatic melanoma: a case report and technical note.

Authors

Fidel Toomey, Mendel Castle-Kirszbaum, Frederick Mariajoseph, Jeremy Kam, Idrees Sher

Published in

Journal of spine surgery (Hong Kong). Volume 12. Issue 6. Pages 102. Jun 30, 2026. Epub May 18, 2026.

Abstract

Advances in oncological therapies have increased survival rates, however, these may result in more patients developing secondary disease processes, including pathological spinal fractures requiring surgical decompression and stabilisation. Traditional open approaches carry significant morbidity, particularly for thoracic anterior column reconstruction. A minimally invasive single-position prone lateral retropleural (PRP) approach allows for optimal surgeon ergonomics, simultaneous anterior and posterior access, releases, deformity correction and fixation, while minimising pleural and tissue disruption, implant point loading and surgical time, and eliminating single-lung ventilation. Endoscope-assistance improves illumination and magnification, improving anatomical localisation and minimising complications. Real-time visualisation may shorten the learning curve.
A 67-year-old man with metastatic melanoma presented with progressive mechanical thoracic pain and myelopathy from a pathological T9 fracture. After initial posterior decompression and fusion, he re-presented 9 months later with hardware failure, fractured rods and subsequent progressive kyphosis. He underwent a mini-thoracotomy and endoscope-assisted minimally invasive PRP T9 corpectomy with posterior construct revision to achieve 360° reconstruction. The endoscope provided visualisation along pleural contours to enable safer vertebrectomy, ventral decompression, neurovascular protection, and cage placement. A titanium quad-rod construct with crosslink reinforced the posterior column. He remained well at 12-month follow-up.
This novel endoscope-assisted PRP case unifies two modern spine surgery techniques, offering a promising minimally invasive alternative for thoracic 360° reconstruction of complex fractures. By enabling simultaneous, single-position anterior and posterior column access and improving deformity correction, surgeon ergonomics and visualisation, it facilitates efficient surgery and could assist in navigating the steep learning curve associated with retropleural access while improving clinical outcomes. Future larger-scale observational studies can help provide insight into the generalisability of the technique and its clinical outcomes.

PMID:
42434586
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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