Technical nuances and approach-related morbidity of anterolateral and posterolateral lumbar corpectomy approaches—a systematic review of the literature

Abstract

Purpose Approaches for lumbar corpectomies can be roughly categorized into anterolateral (AL) and posterolateral (PL) approaches. It remains controversial to date whether one approach is superior to the other, and no comparative studies exist for the two approaches for lumbar corpectomies. Methods A systematic review of the literature was performed through a MEDLINE/PubMed search. Studies and case reports describing technique plus outcomes and possible complications were included. Thereafter, estimated blood loss (EBL), length of operation (LOO), utilized implants, neurological outcomes, complication rates, and reoperation rates were analyzed. Results A total of 64 articles reporting on 702 patients including 513 AL and 189 PL corpectomies were included in this paper. All patients in the PL group were instrumented via the same approach used for corpectomy, while in the AL group the majority (68.3%) of authors described the use of an additional approach for instrumentation. The EBL was higher in the AL group (1393 ± 1341 ml vs. 982 ± 567 ml). The LOO also was higher in the AL group (317 ± 178 min vs. 258 ± 93 min). The complication rate (20.5% vs. 29.1%, p = 0.048) and the revision rate (3.1% vs. 9.5%, p = 0.004) were higher in the PL group. Neurological improvement rates were 43.8% (AL) vs. 39.2% (PL), and deterioration was only noted in the AL group (6.0%), while 50.2% (AL) and 60.8% (PL) showed no change from initial presentation to the last follow-up. Conclusion While neurological outcomes of both approaches are comparable, the results of the present review demonstrated lower complication and revision rates in anterolateral corpectomies. Nevertheless, individual patient characteristics must be considered in decision-making.

Single- and Multilevel Corpectomy and Vertebral body replacement for treatment of spinal infections. A retrospective single-center study of 100 cases

“…The rate of cage subsidence in the thoracolumbosacral subgroup was 3%, consistent with or lower than reported in the literature ( Wipplinger et al, 2022 ; Lu et al, 2009 ). For the cervical spine, there was one case of cage subsidence related to recurrent infection and implant infection.…”

“…For the cervical subaxial spine the anterior approach is the most suitable. Interbody fusion is the more common way, but for similar reasons as for the thoracolumbar spine a corpectomy might be necessary ( Burkhardt et al, 2019 ) ( Walker et al, 2018 ; Schwendner et al, 2023 ; Wipplinger et al, 2022 ).…”