Methods and complications of anterior exposure of the thoracic and lumbar spine

Objective: To review the methods and complications of exposing the anterior aspects of the thoracic and lumbosacral spine. Data Sources: PubMed (journals database of the National Library of Medicine), text books, the University HealthSystem Consortium Clinical Process Improvement Benchmarking Project, a newspaper, and the US government Healthcare Cost and Utilization Project. Study Selection: Descriptions of morbidity and mortality specifically related to anterior spine exposure depicted in both case reports and clinical series were used. Data Extraction: Mortality data from clinical series with more than 30 cases were tabulated. Morbidity incidences were described. Data Synthesis: The frequency of anterior exposure of the spine for structural operations is steadily increasing. Both thoracic and lumbosacral anterior spine operations are associated with exposure-related complication rates of 10% to 50%. Pulmonary complications are frequent after thoracic exposures. Chylothorax is the most common of several rarer chest-exposure complications. Vascular complications, particularly arterial thrombosis (< 1% of cases) and venous bleeding (2%-15% of cases), are the most frequent complications at the lumbar level. Other lumbosacral exposure complications include ureteral and nerve (somatic and sympathetic) injury. The mortality rate in anterior spine exposures is less than 1%. Conclusions: The exposure portions of anterior spine operations result in numerous complications. There are fewer reported complications with endoscopic exposures of the anterior spine than with open exposures, although endoscopic exposures have been used for less complicated cases. In comparable cases, neither exposure nor results of endoscopic operations have proven better than operations done through minilaparotomy incisions. Perioperative cooperation between exposing and spine surgeons is necessary to enhance results in anterior spine operations.