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  • A Thoracoabdominal Approach in the Management of Lower Thoracolumbar Pathologies.

    Final Number:

    Ihab Zidan MD, PhD; Ahmed Farhoud MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: The anterior approach to the thoracic and lumbar spine with corpectomy is a recognized treatment option for various thoracolumbar pathologies. The aim of the study was to evaluate the usefulness of retroperitoneal extrapleural approach (twelfth rib approach) in managing different lumbar and thoracolumbar pathologies as well as its advantages and potential complications.

    Methods: This prospective study was carried out on consecutive 14 patients who had been operated with retroperitoneal extrapleural approach (twelfth rib approach) for different lumbar and thoracolumbar pathologies. Fusion was assessed by plain X-ray films and CT scan, and the neurological outcome by ASIA impairment scale.

    Results: Intraoperative complications had occurred in four cases; peritoneal tear, pleural tear, dural tear and excessive blood loss in one case each. Postoperative complications were reported in four patients. One patient showed neurological deterioration, two cases had wound infection and one patient with a painful scar. The mean operation time was 206 min (range 150–270 min) and the mean volume of blood loss was 535 ml (range 200–1250 ml). Regarding the ASIA impairment scale, nine patients had shown improvement, while five patients remained stationary at the same grade.

    Conclusions: retroperitoneal extrapleural approach (twelfth rib approach) is indicated in the surgery of L1, L2, L3, L4 vertebrae, and for the D12-L1, L1-L2, L2-L3 and L3-L4 discs; the lower half of T12 vertebra can also be reached by this approach and anterior screws can be placed without pleural entry. This approach associated with reduced morbidity as chest cavity is not violated and diaphragm is not cut.

    Patient Care: to create highlights in one of the non familiar approaches to thoraco-lumbar spine although it is a simple and useful approach for spinal surgeons

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) discuss different approaches to thoraco-lumbar junction, 2) identify the indications, technique, and advantages of retroperitoneal-extrapleural approach

    References: 1- Jain AK, Dhammi IK, Jain S, Kumar J. Simultaneously anterior decompression and posterior instrumentation by extrapleural retroperitoneal approach in thoracolumbar lesions. Indian J Orthop. 2010 Oct;44(4):409-16. 2- McAfee PC: Complications of anterior approaches to the thoracolumbar spine. Emphasis on Kaneda instrumentation. Clin Orthop Relat Res 306:110-119, 1994. 3- Payer M, Sottas C. Mini-open anterior approach for corpectomy in the thoracolumbar spine. Surg Neurol. 2008 Jan;69(1):25-31; discussion 31-2. 4- Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A, Pranzl R, Gercek E, Schultheiss M, Weckbach A, Bühren V, Blauth M. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J. 2010 Oct;19(10):1657-76. Epub 2010 May 25.

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