Abstract
The canonical posterior and anterior approaches to the thoracolumbar spine, although effective in providing wide exposure, involve clinically significant morbidity and risk of complications. In particular, diaphragmatic incision and repair can result in immediate and long-term complications, such as hiatal hernia and pneumothorax. The minimally invasive lateral extracoelomic approach was developed with mobilization of the diaphragm anteriorly to facilitate access to the thoracolumbar junction. This mini-open approach to the thoracolumbar spine has resulted in good postoperative outcomes for patients with anterior column pathology. However, evidence is limited to smaller retrospective studies and case series. In this chapter, we examine the relevant anatomy and operative considerations for the mini-open lateral extracoelomic approach to the thoracolumbar junction.
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References
McDonnell MF, Glassman SD, Dimar JR 2nd, Puno RM, Johnson JR. Perioperative complications of anterior procedures on the spine. J Bone Joint Surg Am. 1996;78(6):839–47. Epub 1996/06/01.
Ito H, Tsuchiya J, Asami G. A new radical operation for Pott’s disease: report of ten cases. JBJS. 1934;16(3):499–515.
Hodgson AR, Stock FE. Anterior spinal fusion a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg. 1956;44(185):266–75. Epub 1956/11/01.
Ikard RW. Methods and complications of anterior exposure of the thoracic and lumbar spine. Arch Surg. 2006;141(10):1025–34. Epub 2006/10/18.
Schafer MF. Dwyer instrumentation of the spine. Orthop Clin North Am. 1978;9(1):115–22. Epub 1978/01/01
Heitmiller RF. The left thoracoabdominal incision. Ann Thorac Surg. 1988;46(2):250–3. Epub 1988/08/01
Capener N. The evolution of lateral rhachotomy. J Bone Joint Surg Br. 1954;36-b(2):173–9. Epub 1954/05/01.
Larson SJ, Holst RA, Hemmy DC, Sances A Jr. Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine. J Neurosurg. 1976;45(6):628–37. Epub 1976/12/01.
Resnick DK, Benzel EC. Lateral extracavitary approach for thoracic and thoracolumbar spine trauma: operative complications. Neurosurgery. 1998;43(4):796–802.
Dakwar E, Ahmadian A, Uribe JS. The anatomical relationship of the diaphragm to the thoracolumbar junction during the minimally invasive lateral extracoelomic (retropleural/retroperitoneal) approach. J Neurosurg Spine. 2012;16(4):359–64. Epub 2012/01/10.
Baaj AA, Papadimitriou K, Amin AG, Kretzer RM, Wolinsky JP, Gokaslan ZL. Surgical anatomy of the diaphragm in the anterolateral approach to the spine: a cadaveric study. J Spinal Disord Tech. 2014;27(4):220–3. Epub 2014/05/30.
Moskovich R, Benson D, Zhang ZH, Kabins M. Extracoelomic approach to the spine. J Bone Joint Surg Br. 1993;75(6):886–93. Epub 1993/11/01.
Xu DS, Walker CT, Farber SH, et al. Surgical anatomy of minimally invasive lateral approaches to the thoracolumbar junction. J Neurosurg Spine. 2021;36:1–8. Epub 2022/01/01.
Smith WD, Dakwar E, Le TV, Christian G, Serrano S, Uribe JS. Minimally invasive surgery for traumatic spinal pathologies: a mini-open, lateral approach in the thoracic and lumbar spine. Spine (Phila Pa 1976). 2010;35(26 Suppl):S338–46. Epub 2011/01/05.
Scheufler KM. Technique and clinical results of minimally invasive reconstruction and stabilization of the thoracic and thoracolumbar spine with expandable cages and ventrolateral plate fixation. Neurosurgery. 2007;61(4):798–808. discussion −9. Epub 2007/11/08.
Faro FD, Marks MC, Newton PO, Blanke K, Lenke LG. Perioperative changes in pulmonary function after anterior scoliosis instrumentation: thoracoscopic versus open approaches. Spine (Phila Pa 1976). 2005;30(9):1058–63. Epub 2005/05/03.
Graham EJ, Lenke LG, Lowe TG, et al. Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusion in adolescent idiopathic scoliosis. Spine. 2000;25(18):2319–25.
Vedantam R, Lenke LG, Bridwell KH, Haas J, Linville DA. A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis. Spine (Phila Pa 1976). 2000;25(1):82–90. Epub 2000/01/27.
El Saghir H. Extracoelomic mini approach for anterior reconstructive surgery of the thoracolumbar area. Neurosurgery. 2002;51(5 Suppl):S118–22. Epub 2002/09/18
Kim DH, Jaikumar S, Kam AC. Minimally invasive spine instrumentation. Neurosurgery. 2002;51(5 Suppl):S15–25. Epub 2002/09/18.
Beisse R. Endoscopic surgery on the thoracolumbar junction of the spine. Eur Spine J. 2010;19(Suppl 1(Suppl 1)):S52–65. Epub 2009/08/21
Christiansen PA, Huang S, Smith JS, Shaffrey ME, Uribe JS, Yen CP. Mini-open lateral retropleural/retroperitoneal approaches for thoracic and thoracolumbar junction anterior column pathologies. Neurosurg Focus. 2020;49(3):E13. Epub 2020/09/02.
Payer M, Sottas C. Mini-open anterior approach for corpectomy in the thoracolumbar spine. Surg Neurol. 2008;69(1):25–31. discussion 31−2. Epub 2007/12/07.
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We thank the staff of Neuroscience Publications at Barrow Neurological Institute for the assistance with manuscript preparation.
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Lee, K.E., Rudy, R.F., Uribe, J.S. (2023). Minimally Invasive Thoracolumbar Approaches with Diaphragm Preservation. In: O'Brien, J.R., Weinreb, J.B., Babrowicz, J.C. (eds) Lumbar Spine Access Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-48034-8_31
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DOI: https://doi.org/10.1007/978-3-031-48034-8_31
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