Introduction: Thoracic corpectomies are performed for various reasons including spinal deformity, trauma, neoplasms, and infection. Regardless of indication, both anterior and posterior approaches are surgical options, selected based on pathology, anatomy, patient characteristics, and surgical experience. Risk profiles and outcomes for these procedures are poorly characterized, however, and the choice between the two approaches remains inconclusive. In this study, we compare risk factors and complications for adult patients undergoing anterior and posterior thoracic corpectomies.
Methods: A review of the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database was performed, with 30-day patient outcomes following anterior or posterior thoracic corpectomy queried from 2005 to 2016. Preoperative risk factors and postoperative outcomes (e.g. deaths, reoperations, readmissions) were identified and compared.
Results: 1,327 corpectomies were studied, 861 (64.9%) by an anterior approach and 465 (35.1%) by a posterior approach. Posterior approach patients were generally male, older, and had a higher American Association of Anaesthesiologists’ (ASA) class; while those subject to anterior approaches had a higher average body mass index. After controlling for these baseline characteristics, no significant difference in postoperative events was observed, with 9.3% of anterior approach patients and 7.1% of posterior approach patients returning to the operating room within 30 days.
Conclusions: No significant difference in rates of reoperation, readmission, death, average length of stay, or medical complications exists between anterior and posterior thoracic corpectomy approaches. Both have relatively low risk profiles and, in situations where either strategy is reasonable, each can be selected at the surgeon's discretion with comparable risk.
Patient Care: Thoracic corpectomies are a challenging spine procedure that can be approached either posteriorally or anteriorally. While anatomy traditionally dictates the preferred approach for some patients, in other circumstances the technique is based on personal preference and the availability of a co-surgeon to assist with the approach. This research has the potential to improve patient care by informing the spine surgeon of risk factors associated with poor outcomes for each technique, aiding decision making and allowing the surgeon to better council patients on expectations prior to the operation.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Identify differences in the indications and preoperative risk factors for anterior versus posterior approaches for thoracic corpectomy.
2) Compare rates of reoperation and readmission for anterior and posterior thoracic corpectomy, contrasting their relative risk profiles.
3) Describe the most common reasons for readmission and reoperation for thoracic corpectomy, and council patients on estimates of their likelihood of occurrence.