Comparison of Anterolateral, Lateral Extracavitary and Bilateral Transpedicular Approaches to Thoracolumbar Spine Reconstruction

Gregory J. Przybylski, MD
William Mitchell, MD
Ashwini Sharan, MD (Philadelphia, PA)

Introduction:

Anterolateral (AL) spine approaches offer anterior vertebral visualization, but only reconstruct two columns and frequently need an approach surgeon. Although lateral extracavitary (LEC) and bilateral transpedicular (BTP) approaches allow three column reconstruction, anterior visualization is compromised. This study compares these approaches regarding operative parameters and postoperative complications.

Methods:

Over three years, 58 patients underwent thoracolumbar vertebrectomies for trauma, infection, or neoplasm (25 LEC, 23 BTP, 10 AL). All patients had anterior structural grafting. Additionally, AL patients had anterior plate fixation, whereas LEC and BTP patients had posterior fixation. Parameters compared include demographics, pathology, operative time, blood loss, levels fused and postoperative complications. Statistical comparison was performed with ANOVA using a p=0.05 significance level.

Results:

Three fewer levels were fused in AL compared with LEC/BTR Patients were younger in the LEC (48yr in LEC and 59yr in AL/BTP). Neoplasm was more common in BTP, whereas trauma was more common in AL/LEC. Operative time was I hr longer in AL and 4hr longer in LEC when compared with BTP (p less than 0.05). Likewise, BTP blood loss was 500cc less than AL and 2500cc less than LEC (p less than 0.05). Six of fourteen complications were significant; both perioperative deaths occurred in BTP.

Conclusions:

Anterior and middle column thoracolumbar spinal reconstructions can be performed several ways. Shorter operative time and less blood loss was observed with BTP when compared with AL and LEC approaches. Although posterior approaches are associated with more frequent complications, the BTP approach maybe preferable.