LATERAL EXTRACAVITARY APPROACH TO THE THORACIC AND THORACOLUMBAR SPINE

Twenty-nine patients with anterior spinal cord compression underwent d ecompression and fusion through a laterally based approach to the thor acic and thoracolumbar spine. The lateral extracavitary approach allow s access to the vertebral bodies as well as the posterior elements thr ough a single incision. This approach was chosen for patients who had complicating medical conditions that made staged procedures less desir able. Ten men and 19 women with an average age of 53 years were studie d. Diagnoses included post-traumatic deformity, metastatic disease, os teomyelitis, and primary neoplasms. Twenty-three patients had frank ne urologic loss preoperatively, and 28 patients had significant medical comorbidities as evidenced by American Society of Anesthesiology class es II, III, and IV. One patient died postoperatively from pneumonia, w hich developed in a lung with metastatic disease, and two patients dev eloped seromas that subsequently became infected. The average intensiv e care unit stay was less than 2 days. Patients remained intubated for an average of 13 hours after surgery. In this population of medically compromised patients with difficult spinal disease, the lateral extra cavitary approach provided an effective means of one-stage treatment. Patients tolerated the procedure, and cardiopulmonary complications we re minimal. This approach is most appropriate in patients who require posterior stabilization in conjunction with anterior stabilization.