Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine

Larson, Sanford J.; Holst, Robert A.; Hemmy, David C.; Sances, Anthony

doi:10.3171/jns.1976.45.6.0628

Cited by 289 publications

(90 citation statements)

References 12 publications

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“…5,[12][13][14]18,34,35,41,43,44,57,59,64 Costotransversectomy was first described by Menard 48 in 1894 for drainage of tuberculous abscesses in patients with Pott paraplegia. Various modifications of this procedure have been developed for removal of anterior thoracic disc herniation, 32,33,40,56,62 traumatic lesions, 40 and metastatic tumors of the spine. 15,55 In the present study we have attempted to elucidate the perioperative complications in patients with thoracic and thoracolumbar neoplasms undergoing either thoracotomy or thoracolumbar approaches compared with costotransversectomy.…”

Section: Discussionmentioning

confidence: 99%

“…When used in conjunction with posterior instrumentation, costotransversectomy has proven to be a successful method in the management of patients with metastatic lesions to the thoracic spine. 5,11,13,14,38,40 In many of these studies the complication rates for costotransversectomies have been reported to be very low. It is difficult to believe that major operations such as costotransversectomies for thoracic neoplasms can be performed with such low morbidity given the significant Neurosurg Focus 11 (6): Article 4, 2001, Click here to return to Table of Contents Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors complication rate associated with thoracic pedicle screw placement alone.…”

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confidence: 99%

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Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Wiggins¹,

Mirza²,

Bellabarba³

et al. 2001

FOC

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Object Anterior decompression and stabilization for thoracic spinal tumors often involves a thoracotomy and can be associated with surgical approach–related complications. An alternative to thoracotomy is surgery via a costotransversectomy exposure. To delineate the risks of surgery, the authors reviewed their prospective database for patients who had undergone surgery via either of these approaches for thoracic or thoracolumbar tumors. The complications were recorded and graded based on severity and risk of impact on patient outcome. Methods Between September 1995 and April 2001, the authors performed 29 costotransversectomies (Group 1) and 18 thoracolumbar or combined (Group 2) approaches as initial operations for thoracic neoplasms. The age, sex, pre-operative motor score, and preoperative Frankel grade did not significantly differ between the groups. In the costotransversectomy group there were greater numbers of metastases, upper thoracic procedures, and affected vertebral levels; additionally, the comorbidity rate based on Charlson score, was higher. The mean Frankel grades at discharge were not significantly different whereas the discharge motor and last follow-up motor scores were better in Group 2. There were 11 Group 1 and seven Group 2 patients who suffered at least one complication. The number or patients with complications, the mean number of complications, and severity of complications did not differ between the groups. Conclusions Compared with anterior or combined approaches, the incidence and severity of perioperative complications in the surgical treatment of thoracic and thoracolumbar spinal tumors is similar in patients who undergo costotransversectomy. Costotransversectomy may be the preferred operation in patients with significant medical comorbidity or tumors involving more than one thoracic vertebra.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Wiggins¹,

Mirza²,

Bellabarba³

et al. 2001

FOC

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“…If so, should Harrington instrumenta tion be combined with decompression, whether from the anterior, the anterolateral, the posterolateral or the posterior approach? (Schmidek et at., 1977;Larson et at., 1976;Riska and Myllynen, 1981;Bohlman and Eismont, 1981;Dolan et at., 1980;Paul et at., 1977;Wang et at., 1979;Young et at., 1981). The purpose of this paper is to report the gradual evolution of a philosophy as it applies to spinal injuries at the thoracolumbar junction.…”

Section: Introductionmentioning

confidence: 99%

Fractures of the thoraco-lumbar spine

1985

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SummaryA personal prospective study of 98 consecutive patients presenting with neurological impairment and fractures or dislocations between the 9th thoracic and 2nd lumbar vertebrae bodies. Fifty-three patients underwent Harrington instrumentation, and 45 patients were treated recumbently. Neurological improvement was much better fo llowing Harrington rods in the complete paraplegia group but there was no dif ference in neurological recovery between the two groups in those with incomplete paraplegia. Forty-two patients who had been stabilised with Harrington rods underwent post-operative myelography or tomography to assess the adequacy of sp inal decompression. The best results were in patients with adequate neural canal decompression. In 21 cases decompression had not been adequate, usually due to a stereotyped pattern in which the postero-superior aspect of the fractured body remained in the neural canal. All 21 underwent anterior decompression at an average of five months post injury. All the incomplete paraplegics (nine patients) regained the ability to walk, three of the 12 complete paraplegics improved and regained the ability to walk with bilateral ankle-foot orthoses. Neurological improvement was dependent upon the adequacy of spinal cord decompression and not upon Harrington rods. per se. Harrington rods alone were not adequate to decompress the spinal canal in 50 per cent of cases. The best results after anterior decompression occurred where neural compression was caused by a minimally displaced wedge fr acture distal to T12.

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“…16 This approach provides dorsal and ventrolateral access to the thoracolumbar spine without the morbidity associated with traditional transpleural and transperitoneal approaches. Additionally, it allows for posterior instrumentation through the same surgical incision.…”

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confidence: 99%

“…

T he lateral extracavitary approach (LECA) to the thoracolumbar spine was originally described by Larson et al in 1976 for the treatment of traumatic pathology. 16 This approach provides dorsal and ventrolateral access to the thoracolumbar spine without the morbidity associated with traditional transpleural and transperitoneal approaches.

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confidence: 99%

The lateral extracavitary approach to the thoracolumbar spine: a case series and systematic review

Foreman¹,

Naftel

Moore

et al. 2016

SPI

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OBJECT Since its introduction in 1976, the lateral extracavitary approach (LECA) has been used to access ventral and ventrolateral pathology affecting the thoracolumbar spine. Reporting of outcomes and complications has been inconsistent. A case series and systematic review are presented to summarize the available data. METHODS A retrospective review of medical records was performed, which identified 65 consecutive patients who underwent LECA for the treatment of thoracolumbar spine and spinal cord pathology. Cases were divided according to the presenting pathology. Neurological outcomes and complications were detailed. In addition, a systematic review of outcomes and complications in patients treated with the LECA as reported in the literature was completed. RESULTS Sixty-five patients underwent the LECA to the spine for the treatment of thoracic spine and spinal cord pathology. The most common indication for surgery was thoracic disc herniation (23/65, 35.4%). Neurological outcomes were excellent: 69.2% improved, 29.2% experienced no change, and 1.5% were worse. Two patients (3.1%) experienced a complication. The systematic review revealed comparable neurological outcomes (74.9% improved) but a notably higher complication rate (32.2%). CONCLUSIONS The LECA provides dorsal and unilateral ventrolateral access to and exposure of the thoracolumbar spine and spinal cord while allowing for posterior instrumentation through the same incision. Although excellent neurological results can be expected, the risk of pulmonary complications should be considered.

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Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine

Cited by 289 publications

References 12 publications

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Fractures of the thoraco-lumbar spine

The lateral extracavitary approach to the thoracolumbar spine: a case series and systematic review

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