LATERAL EXTRACAVITARY APPROACH FOR THORACIC AND THORACOLUMBAR SPINE TRAUMA - OPERATIVE COMPLICATIONS

BACKGROUND: The lateral extracavitary approach (LECA) to the thoracic and thoracolumbar spine allows ventral decompression and dorsal fixati on of the spine through the same incision during a single procedure. T he approach, however, is technically demanding and time-consuming. We sought to determine the incidence of complications associated with the LECA in patients with acute thoracolumbar spine injuries. PATIENTS AN D METHODS: A retrospective chart review of all patients with acute fra ctures or dislocations of the thoracic or thoracolumbar spine who unde rwent surgery via the LECA was conducted to assess the incidence and t ype of perioperative complications associated with the LECA. RESULTS: Thirty-three patients with thoracic or thoracolumbar spine injuries tr eated using the LECA between June 1990 and June 1996 were identified a nd had available medical records. Complications occurred in 18 of thes e patients. Pulmonary complications predominated. Eleven patients requ ired tube thoracostomy for hemothorax or persistent pleural effusions, and seven patients developed postoperative pneumonia. There were no c ases of neurological worsening. There was no mortality. CONCLUSION: De compression and stabilization of acute thoracolumbar fractures with th e LECA in the acute setting is associated with a 55% incidence of morb idity. Whereas some of this morbidity may be attributed to the effects of the injury, there is a certain intrinsic morbidity associated with the LECA. Although this morbidity may compare favorably with that of sequential ventral/dorsal approaches, the biomechanical advantages obt ained with a combined ventral and dorsal construct must be balanced ag ainst the inherent morbidity of such approaches.