Evaluation of 11th rib extrapleural-retroperitoneal approach to the thoracolumbar junction - Technical note

Object. The 11th rib extrapleural-retroperitoneal approach offers an altern ative means for access to the thoracolumbar junction. It provides excellent operative exposure without the need to transgress the diaphragm, resulting in less morbidity and reduced risk of pulmonary complications. This approa ch, however, has been dismissed by many surgeons offering the unsubstantiat ed criticism that it affords limited access. Thus far, only technical descr iptions of the operative procedure are available in the literature, without documentation of the clinical outcomes of these patients. In the current study the authors describe the 11th rib extrapleural-retrope ritoneal approach to the thoracolumbar junction, and they evaluate the asso ciated early and late morbidity in these patients. Methods. From September 1996 to August 1999, the authors collected prospect ive data of consecutive patients who underwent surgery for a variety of pat hological conditions of the thoracolumbar junction via this approach. In 26 consecutive patients requiring an anterior spinal procedure,lesions locate d between T-10 and T-11 were studied and followed for a mean period of 17 m onths (range 1-36 months). There were 13 men and 13 women whose mean age wa s 47 years (range 16-80 years), with the following pathological entities: t rauma (13 cases), neoplasm (six cases), infection (two cases), and deformit y (five cases). There were no cases of neurological deterioration. There we re no significant pulmonary complications, and only one patient required in sertion of a postoperative chest tube. Conclusions. The 11th rib extrapleural-retroperitoneal approach was success fully used to treat patients with a variety of lesions in the thoracolumbar junction and was associated with little morbidity. The authors believe tha t previous criticism suggesting that this approach provides only limited ac cess is unsubstantiated.