Simultaneous anterior and posterior approaches to the spine for revision surgery: Current indications and techniques

Revision spinal surgery often requires attention to both the anterior and t he posterior portions of the spine. Staged, sequential, and more recently s imultaneous anterior and posterior approaches have been proposed. A simulta neous approach has the distinct advantage of allowing complete and constant control of the anterior and posterior portions of the spine during surgery . The simultaneous approach has been shown to offer decreased operating tim e, blood loss, complication rate, and hospital length of stay as compared w ith staged procedures. The evolution in spinal instrumentation and ancillar y equipment has greatly advanced the simultaneous technique. The developmen t of a special operating table has facilitated patient positioning and intr aoperative patient adjustments, optimizing operative exposure for the anter ior and posterior surgical teams. The two-rod and four-rod techniques offer the surgeon the possibility to safely address complex deformities, particu larly in kyphosis.