Document Type : Original Article
Department of Neurosurgery, D. Y. Patil Medical College and Hospital, Pimpri, Pune, India.
Background Data: Anterior approaches to the thoracic and thoracolumbar spine have several advantages including direct access to the lesion, less surgical bleeding, low risk of infection, and shorter segment fixation devices. It provides excellent visualization and access to the anterior thoracic spine, vertebral bodies, intervertebral disks, spinal canal, and nerve roots and may improve neurological outcome.
Purpose: To evaluate various outcome parameters of the anterior approach to the thoracolumbar spine of various pathologies.
Study Design: Prospective clinical case study.
Patients and Methods: Thirty patients were included in this study. Patients with infections, malignancy, and trauma were included, while patients with medical comorbidities, extensive several spinal levels disease, posterior tension band injury and translational or rotational injury, and severe osteopenia or osteoporosis were excluded. The evaluation included the demographic data, clinical features, level of injury, and neurological status of these patients. All patients underwent operation through the anterior thoracolumbar approach. Outcome parameters included preoperative and perioperative data and postoperative ASIA, VAS, SCIM, and ODI.
Results: The age of patients was 46.06±12.2 (range, 20–70) years. Twenty patients were males and 10 were females. Most patients were 41–50 and >50 years. Thirteen patients (43%) suffered from traumatic fractures (M:F 3.3:1), 14 (47%) tuberculous spondylodiscitis (M:F 1.8:1), and 3 (10%) metastatic compression fracture. Surgical time was 213.12 and 201.43 minutes in Rt and Lt side approach, respectively, while blood loss was 609.4 and 650 ml in Rt and Lt side approach, respectively. In the whole group, pre- and postoperative sensory ASIA score was 91.53 and 105.8; motor ASIA score was 66.2 and 77.13; VAS was 5.13 and 0.63; SCIM was 30.93 and 76.13; ODI was 74 and 16.53, respectively. Complications included wound infection (N=3), kyphosis (N=3), intraoperative vascular injury (N=2), new neurological deficit (N=2), and myocardial infarction (N=1).
Conclusion: Anterolateral approach in thoracic and thoracolumbar pathologies achieves adequate decompression, pathological evaluation for tissue, the possibility for instrumentation, and favorable neurological outcome. The familiarity and experience of the surgeon with the approach will always remain a cornerstone for the success of the procedure. (2020ESJ204)