Approach-related complications of transthoracic spinal reconstruction procedures

Direct surgical repair of instabilities of the anterior spinal column has gained in importance. New techniques and instruments have led to better operative results. Inspite of the growing number of interventions at the anterior spinal column only little data is available on the typical intra- and postoperative complications of these anterior approaches. Between 4/1998 and 8/2002, 85 patients in two neurosurgical centres were treated using an anterolateral transthoracic approach for various lesions of the thoracic and thoracolumbar spine. We used a minithoracotomy with video-endoscopic guidance in 75 of these patients. Intra- and postoperative complications were evaluated retrospectively. Two operations had to be abandoned, in all other cases surgery was performed as planned. Postoperatively, eleven patients complained of temporary intercostal neuralgia (12.9%), two patients (2.3%) had a pulmonary insufficiency which was treated conservatively, another patient needed drainage of a pleural effusion. One intraoperative injury to the thoracic duct was treated conservatively, one hernia of the abdominal wall had to be corrected surgically. Relevant injuries to the vessels did not occur, blood loss was 520 ml on average. There was no surgical mortality; one revision surgery had to be performed because of bone graft dislocation. The rate of severe approach-related complications was 4/ 85 = 4.7% (two abandoned procedures, one injury to the thoracic duct, one abdominal hernia). Transthoracic anterolateral stabilisation via a minithoracotomy with video-endoscopic guidance is an effective surgical approach to treat instabilities of the anterior parts of the thoracic spine and the thoracolumbar area with low complication rates.