THE ANTERIOR EXTRAPLEURAL APPROACH TO THE THORACOLUMBAR JUNCTION REVISITED

General surgeons often provide the exposure for the anterior repair of vertebral body lesions. The standard anterior approach to the thoraco lumbar junction (T-11-L-1) is a transpleural 9th or 10th rib thoracoab dominal incision, From October 1995 through March 1997, 22 patients un derwent anterior repair of thoracolumbar junction vertebral lesions th rough an alternative 11th rib resection while maintaining an extrapleu ral approach. Exposure was excellent, as judged by the neurosurgical t eam completing the repairs. Chest tubes were not used routinely, and a ll patients healed without complications. A major limitation of the 11 th rib extrapleural approach to the thoracolumbar junction has been po or exposure. This problem is eliminated with the use of an abdominal s elf-retaining retractor system. With many potential advantages to this 11th rib exposure (less pain, fewer pulmonary problems, and better wo und healing), we consider the 11th rib incision to be the approach of choice to the thoracolumbar junction and recommend renewed interest in this incision.