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

    Final Number:

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

    Study Design:

    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.

    References: 1. Larson SJ, Holst RA, Hemmy DC, Sances A, Jr. Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine. Journal of neurosurgery. 1976;45:628-637 2. Ditunno JF, Jr., Young W, Donovan WH, Creasey G. The international standards booklet for neurological and functional classification of spinal cord injury. American spinal injury association. Paraplegia. 1994;32:70-80 3. Lifshutz J, Lidar Z, Maiman D. Evolution of the lateral extracavitary approach to the spine. Neurosurgical focus. 2004;16:E12 4. Ménard V. Causes de la paraplegia dans le mal de pott. Son traitement chirurgical par l’ouverture direct du foyer tuberculeux des vertebras. Rev Orthop. 1894;5:47-64 5. Capener N. The evolution of lateral rhachotomy. The Journal of bone and joint surgery. British volume. 1954;36-B:173-179 6. Seddon HJ. Pott's paraplegia: Prognosis and treatment. Br J Surg. 1935;22:769 7. Voulgaris S, Alexiou GA, Mihos E, Karagiorgiadis D, Zigouris A, Fotakopoulos G, et al. Posterior approach to ventrally located spinal meningiomas. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2010;19:1195-1199 8. Steck JC, Dietze DD, Fessler RG. Posterolateral approach to intradural extramedullary thoracic tumors. Journal of neurosurgery. 1994;81:202-205 9. Solero CL, Fornari M, Giombini S, Lasio G, Oliveri G, Cimino C, et al. Spinal meningiomas: Review of 174 operated cases. Neurosurgery. 1989;25:153-160 10. Benson MK, Byrnes DP. The clinical syndromes and surgical treatment of thoracic intervertebral disc prolapse. The Journal of bone and joint surgery. British volume. 1975;57:471-477 11. Logue V. Thoracic intervertebral disc prolapse with spinal cord compression. Journal of neurology, neurosurgery, and psychiatry. 1952;15:227-241 12. Morgan TH, Wharton GW, Austin GN. The results of laminectomy in patients with incomplete spinal cord injuries. Paraplegia. 1971;9:14-23 13. Benzel EC. The lateral extracavitary approach to the spine using the three-quarter prone position. Journal of neurosurgery. 1989;71:837-841 14. Champlin AM, Rael J, Benzel EC, Kesterson L, King JN, Orrison WW, et al. Preoperative spinal angiography for lateral extracavitary approach to thoracic and lumbar spine. AJNR. American journal of neuroradiology. 1994;15:73-77 15. Forbes G, Nichols DA, Jack CR, Jr., Ilstrup DM, Kispert DB, Piepgras DG, et al. Complications of spinal cord arteriography: Prospective assessment of risk for diagnostic procedures. Radiology. 1988;169:479-484 16. Maiman DJ, Larson SJ, Benzel EC. Neurological improvement associated with late decompression of the thoracolumbar spinal cord. Neurosurgery. 1984;14:302-307 17. Dietze DD, Jr., Fessler RG. Thoracic disc herniations. Neurosurg Clin N Am. 1993;4:75-90 18. Maiman DJ, Larson SJ, Luck E, El-Ghatit A. Lateral extracavitary approach to the spine for thoracic disc herniation: Report of 23 cases. Neurosurgery. 1984;14:178-182 19. Delfini R, Di Lorenzo N, Ciappetta P, Bristot R, Cantore G. Surgical treatment of thoracic disc herniation: A reappraisal of larson's lateral extracavitary approach. Surg Neurol. 1996;45:517-522; discussion 522-513 20. Arnold PM, Baek PN, Bernardi RJ, Luck EA, Larson SJ. Surgical management of nontuberculous thoracic and lumbar vertebral osteomyelitis: Report of 33 cases. Surg Neurol. 1997;47:551-561 21. Resnick DK, Benzel EC. Lateral extracavitary approach for thoracic and thoracolumbar spine trauma: Operative complications. Neurosurgery. 1998;43:796-802; discussion 802-793 22. Lubelski D, Abdullah KG, Mroz TE, Shin JH, Alvin MD, Benzel EC, et al. Lateral extracavitary vs. Costotransversectomy approaches to the thoracic spine: Reflections on lessons learned. Neurosurgery. 2012;71:1096-1102 23. Graham AW, 3rd, Mac Millan M, Fessler RG. Lateral extracavitary approach to the thoracic and thoracolumbar spine. Orthopedics. 1997;20:605-610

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy