Mini-open lateral retropleural/retroperitoneal approaches for thoracic and thoracolumbar junction anterior column pathologies.

OBJECTIVE Advancements in less invasive lateral retropleural/retroperitoneal approaches aim to address the limitation of posterolateral approaches and avoid complications associated with anterior open thoracotomy or thoracoabdominal approaches. METHODS Consecutive patients treated with a mini-open lateral approach for thoracic or thoracolumbar anterior column pathologies were analyzed in a retrospective case series including clinical and radiographic outcomes. Special attention is given to operative techniques and surgical nuances. RESULTS Eleven patients underwent a mini-open lateral retropleural or combined retropleural/retroperitoneal approach for thoracic or thoracolumbar junction lesions. Surgical indications included chronic fracture/deformity (n = 5), acute fracture (n = 2), neoplasm (n = 2), and osteomyelitis (n = 2). The mean length of postoperative hospital stay was 7.2 days (range 2-19 days). All patients ultimately had successful decompression and reconstruction with a mean follow-up of 16.7 months (range 6-29 months). Axial back pain assessed by the visual analog scale improved from a mean score of 8.2 to 2.2. Complications included 1 patient with deep venous thrombosis and pulmonary embolism and 1 with pneumonia. One patient developed increased leg weakness, which subsequently improved. One patient undergoing corpectomy with only lateral plate fixation developed cage subsidence requiring posterior stabilization. CONCLUSIONS Mini-open lateral retropleural and retroperitoneal corpectomies can safely achieve anterior column reconstruction and spinal deformity correction for various thoracic and thoracolumbar vertebral pathologies.

[1]  Donald A. Smith,et al.  The Minimally Invasive Lateral Retropleural and Retroperitoneal Approaches in Patients with Thoracic and Lumbar Osteomyelitis: Description of the Techniques and a Series of 14 Patients. , 2020, World neurosurgery.

[2]  Juan S. Uribe,et al.  Mini-Open Lateral Corpectomy for Thoracolumbar Junction Lesions. , 2020, Operative neurosurgery.

[3]  Juan S. Uribe,et al.  Mini-open Lateral En Bloc Corpectomy: Cadaveric Feasibility and Early Clinical Experience , 2019, Clinical spine surgery.

[4]  J. Uribe,et al.  LABORATORY INVESTIGATION , 2005 .

[5]  Tien V. Le,et al.  Minimally Invasive Surgery for Traumatic Spinal Pathologies: A Mini-Open, Lateral Approach in the Thoracic and Lumbar Spine , 2010, Spine.

[6]  Xie Xi-zhong Evaluation of 11th rib extrapleural-retroperitoneal approach to the thoracolumbar juntion , 2008 .

[7]  K. Scheufler TECHNIQUE AND CLINICAL RESULTS OF MINIMALLY INVASIVE RECONSTRUCTION AND STABILIZATION OF THE THORACIC AND THORACOLUMBAR SPINE WITH EXPANDABLE CAGES AND VENTROLATERAL PLATE FIXATION , 2007, Neurosurgery.

[8]  S. Konno,et al.  Necessity of Rib Head Resection for Anterior Discectomy in the Thoracic Spine , 2004, Spine.

[9]  H. El Saghir Extracoelomic mini approach for anterior reconstructive surgery of the thoracolumbar area. , 2002, Neurosurgery.

[10]  J. Finkelstein,et al.  Evaluation of 11th rib extrapleural-retroperitoneal approach to the thoracolumbar junction. Technical note. , 2000, Journal of neurosurgery.

[11]  John R. Johnson,et al.  Perioperative Complications of Anterior Procedures on the Spine*† , 1996, The Journal of bone and joint surgery. American volume.

[12]  R. Moskovich,et al.  Extracoelomic approach to the spine. , 1993, The Journal of bone and joint surgery. British volume.