The Lateral Extracavitary Approach for Primary Single Stage Decompression, Arthrodesis, and Instrumentation of Thoracic and Lumbar Lesions: Clinical Outcomes in 32 Consecutive Patients at 1-year

32 patients were treated with the lateral extracavitary approach over 1 to 3 levels (from a far lateral trajectory). Limited rib resections were performed in thoracic lesions. 2-5 level laminectomies and factectomies were performed with near total corpectomies to achieve circumferential resection and decompression of the neural elements. Interbody arthrodesis and stabilization was then performed with use of a graft or cage packed with local, autograft, and allograft bone. Dorsal stabilization with pedicle screw instrumentation was either 1 or 2 levels above and below the lesion segment with additional contralateral posterolateral arthrodesis. 19 men and 13 women were treated with a mean age of 43 years old. There were 6 cases of tuberculous spondylitis, 8 bacterial osteomyelitides, 11 metastatic tumors, 4 primary bone tumors, and 8 traumatic or insufficiency fractures. There were 25 single level, 5 two-level, and 2 three-level corpectomies/lesion resections performed. The average operative time was 4 hrs 50 minutes with a range of 3.5 hrs to 12hrs. Blood loss ranged from 595cc with a range of 250 to 2700cc. Structural allograft bone was used in 11 cases with a prosthetic titanium cage used in the remaining cases. The postoperative length of stay was 8.5 days which was prolonged due to the need for adjuvant radiation and/or drug therapy in the majority of cases. Surgical complications included transient weakness (7), permanent new weakness (2), postoperative infection (2), pleural effusion (2), hemothorax requiring treatment (1), retroperitoneal hematoma (1), delayed csf leak (1), and symptomatic hardware failure requiring revision (2). The mean follow up was 15.2 months with an overall radiographic fusion with no motion on flexion-extension and bridging bone seen in 28 cases (87.5%).