Anterior/Anterolateral Thoracic Access and Stabilization from Posterior Approach: Transpedicular, Costotransversectomy, Lateral Extracavitary Approaches: Standard Intralesional Resection

A Single Stage Dorsal Corpectomy, Reconstruction and Stabilization; Can We Depend on the Costotransversectomy Approach?

“…With gaining of neurosurgical expertise and advanced surgical hardware, surgical approaches to the anterior thoracic spine have evolved over the past decades to decrease the morbidity rates, enhance the postoperative fusion, and enhance the clinical outcomes. 8 The posterolateral approaches have numerous advantages over the anterior approaches when considering the management of thoracic spine disease, as they provide proper and effective management of different pathologies in a single surgical session. On the other hand, the anterior approach not only provides poor fixation points, but it also could increase the risk of catastrophic pulmonary complications, leading to increased hospitalization periods and associated healthcare costs.…”

“…The surgical field becomes wider as one chooses the approach from the former to the later, respectively, allowing better visualization, hence better ventral decompression, but with more tissue devitalization. [3][4][5][6][7][8] The transpedicular approach through a dorsal midline incision can achieve effective posterior decompression, posterolateral vertebrectomy, coupled with posterior transpedicular fixation even for multiple levels in a single session. This technique is familiar to many spine surgeons, and surely avoids the high morbidity complicating whether the anterior approach or the combined anterior and posterior approaches, hence it is considered an ideal approach for severely ill patients.…”

“…3,4 The costotransversectomy approach, via a posterior midline incision, with exposure and resection of the proximal 4-6 cm of the related rib can deal with multiple levels pathology and allow proper transpedicular fixation, still with acceptable complications rate. 5,[7][8][9] The costotransversectomy with an oblique trajectory with difficult visualization angle to ventral spinal pathologies may be technically demanding, with potential inadequate decompression for ventral midline pathologies. Also sometimes, it may be associated with difficult ventral reconstruction.…”

“…Furthermore, there is a potential risk of pleural or vascular injuries, in addition to late identification of the segmental vessels increasing the risk of blood loss. 8,10 This study aimed at evaluating the perioperative and the two-year outcomes of the costotransversectomy approach in patients with different thoracic spine pathologies, assessing safety and efficacy and identifying the risk factors increasing the perioperative morbidity.…”