Lateral extracavitary approach for thoracic and thoracolumbar spine trauma: Operative complications

BACKGROUND: The lateral extracavitary approach (LECA) to the thoracic and thoracolumbar spine allows ventral decompression and dorsal fixation of the spine through the same incision during a single procedure. The approach, however, is technically demanding and time-consuming. We sought to determine the incidence of complications associated with the LECA in patients with acute thoracolumbar spine injuries. PATIENTS AND METHODS: A retrospective chart review of all patients with acute fractures or dislocations of the thoracic or thoracolumbar spine who underwent surgery via the LECA was conducted to assess the incidence and type of perioperative complications associated with the LECA. RESULTS: Thirty-three patients with thoracic or thoracolumbar spine injuries treated using the LECA between June 1990 and June 1996 were identified and had available medical records. Complications occurred in 18 of these patients. Pulmonary complications predominated. Eleven patients required tube thoracostomy for hemothorax or persistent pleural effusions, and seven patients developed postoperative pneumonia. There were no cases of neurological worsening. There was no mortality. CONCLUSION: Decompression and stabilization of acute thoracolumbar fractures with the LECA in the acute setting is associated with a 55% incidence of morbidity. Whereas some of this morbidity may be attributed to the effects of the injury, there is a certain intrinsic morbidity associated with the LECA. Although this morbidity may compare favorably with that of sequential ventral/dorsal approaches, the biomechanical advantages obtained with a combined ventral and dorsal construct must be balanced against the inherent morbidity of such approaches.