The Morbidity of an Anterior Thoracolumbar Approach in Adult Patients with Greater than Five-Year Follow-Up

Methods: A specific questionnaire was used to evaluate long-term follow-up (average 10.1 years, range 5-19) of 28 adult patients who underwent spinal deformity surgery performed through an anterior thoracolumbar approach. Thirteen patients had over a 10-year follow-up and nine were between 5 to 10 years postoperative. The questionnaire is composed of detailed scar-related sub-questions of pain, appearance, bulging, daily life, and patient's personal opinion of surgery.

Results: The average age and number of anterior fusion levels was 50.5 (range 32-74) and 5.4 (range 2-10), respectively. Although 92.8% patients (26/28) were satisfied with the results of their surgery in general, some of patients were dissatisfied with aspects related to their anterior incision. For the pain domain, seven patients (25%, one with more than 10 year follow-up and six with 5 year) rated their pain over the thoracolumbar scar as moderate to severe. Six patients (21.4%) felt they had a poor outcome related to their postoperative appearance. Fourteen patients (50%) had bulging of their scar, two were surgically indicated for repair, and one patient had multiple surgical repairs. Seven patients (25%) showed limitations in activities of daily living due to their anterior incision. One patient with more than 10 years follow-up and four with more than 5 years follow-up felt they were getting worse.

Conclusion: This is the first long-term (min. 5 years) follow-up study focusing on patient outcomes following an anterior thoracolumbar approach for spinal deformity treatment. This approach appears to be associated with a high rate of postoperative pain (25%), bulging (50%), and functional disturbance (25%). Therefore, surgeons should use caution when recommending this approach to future adult spinal deformity patients.