Anterior Approaches to the Thoracolumbar Spine

Abstract

This topic reviews three anterior approaches to the thoracolumbar spine: thoracotomy, retroperitoneal flank approach, and the pararectus retroperitoneal approach.

Thoracotomy is used to expose vertebral bodies from T3-T12; debride vertebral osteomyelitis or diskitis; for anterior vertebral body tumor excision; for corpectomy for thoracic burst fractures; for thoracic diskectomies or fusion; and for anterior release with or without instrumentation in surgery to correct deformity.

The retroperitoneal flank approach is used for fusions from L1-4 with placement of lateral interbody implants; for debridement of vertebral osteomyelitis or diskitis; for vertebral body tumor excision; for decompression and stabilization in fractures from T12 to L4; and for anterior release and stabilization for scoliosis.

The pararectus retorperitoneal approach is used to expose the anterior aspect of vertebral bodies from L4 to S1; for interbody fusion of L4-5 and L5-S1; for débridement of vertebral osteomyelitis or diskitis; for anterior vertebral body tumor excision; and for anterior release for deformity. It is not considered to be appropriate if there is prior inflammatory or infectious disease in the anatomic region; if there is prior surgery with consequent adhesions or endometriosis, or if exposure of vertebral bodies is difficult, even hazardous.

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