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  • The Lateral Extracavitary Approach to the Thoracolumbar Spine: A Case Series and Systematic Review

    Final Number:
    1260

    Authors:
    Paul M Foreman MD; Robert Partlow Naftel MD; Thomas A. Moore; Mark N. Hadley MD, FACS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Since its introduction in 1976, the lateral extracavitary approach (LECA) has been used to access ventral and ventrolateral pathology affecting the thoracolumbar spine. Reporting of outcomes and complications has been inconsistent. A case series and systematic review are presented to summarize the available data.

    Methods: A retrospective review of the medical record was performed identifying 65 consecutive patients undergoing the LECA for the treatment of thoracolumbar spine and spinal cord pathology. Cases were divided by the presenting pathology. Neurologic outcomes and complications were detailed. In addition, a systematic review of outcomes and complications in patients treated with the LECA was completed.

    Results: Sixty-five patients underwent the LECA to the spine for the treatment of thoracic spine and spinal cord pathology. The most common indication for surgery was a thoracic disc herniation (35.4%). Neurologic outcomes were excellent: 69.2% improved, 29.2% no change, and 1.5% worse. Two (3.1%) patients experienced a complication. The systematic review revealed comparable neurologic outcomes (74.9% improved), but a notably higher complication rate (32.2%).

    Conclusions: The LECA provides ipsilateral ventrolateral access to the thoracolumbar spine and spinal cord while allowing for posterior instrumentation through the same incision. While excellent neurologic results can be expected, the risk of pulmonary complications should be considered.

    Patient Care: This manuscript provides a comprehensive evaluation and discussion of the LECA to the thoracolumbar spine. It serves to familiarize the surgeon with the indications, technique, complications, and outcomes. Additionally technical nuances are presented that can be incorporated into future practice.

    Learning Objectives: By the conclusion of this session, participants should: 1) understand the basics of the LECA, 2) be able to identify pathology suitable to the approach, 3) comprehend the risks and benefits of the approach, 4) and walk away with an appreciation for the technical nuances of the procedure.

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