Extracoelomic mini approach for anterior reconstructive surgery of the thoracolumbar area

OBJECTIVE: An extracoelomic mini approach is introduced as a less invasive technique for surgery of the thoracolumbar area performed via the anterior approach. METHODS. Twenty-one patients with spinal pathological findings at the thoracolumbar junction were assessed. The reasons for surgery were as follows: burst fracture of the first lumbar vertebra (n = 5), degenerative disc at L1-L2 (n = 4), spondylodiscitis at L1-L2 (n = 8) and at T11-L1 (n = 1), pathological fracture of the first lumbar vertebra (n = 2), and pseudarthrosis at T11-L1 after failed reconstruction (n = 1). The anterior surgical procedure was performed via an extracoelomic mini approach. Intersomatic fusion was performed in 13 patients, corpectomy and bone grafting in 4, corpectomy and vertebral replacement with titanium cage packed with bone cement in 3, and removal of a cage in a failed fusion and bridging the defect with a strut bone graft in 1. Posterior instrumentation of the affected segment was performed in the same sitting. RESULTS: The mean +/- standard deviation of operative time of the anterior procedure was 101.2 +/- 36.5 minutes. The mean blood loss during the anterior procedure was 724 +/- 483.5 ml. The procedure was safe. No pseudarthrosis was encountered, and the reconstructed bone was stable in the three patients in whom bone cement was used. CONCLUSION: The extracoelomic mini approach is less invasive; it results in less incisional morbidity, and it avoids opening the pleural and peritoneal cavities.