Indications and techniques for anterior-only and combined anterior and posterior approaches for thoracic and lumbar spine deformities.

Over the past several years, anterior treatment of spinal pathologies has gained popularity. Currently, there is much debate about the relative advantages of the thoracoscopic approach versus open thoracotomy, and laparoscopic over open lumbar surgery. Also, there is evolving information regarding patient morbidity after anterior treatment for spinal pathologies. Clearly, the anterior, middle, and posterior columns of the spine must be assessed before treatment is initiated. For one- or two-level pathologies, often the anterior column can be accessed in the thoracic spine through the pedicles, facetjoints, transverse processes, and ribs on one side (costotransversectomy). Similarly, in the lumbar spine the disks can be approached as either a posterior lumbar interbody fusion or a transforaminal lumbar interbody fusion procedure. For multilevel pathologies, usually a separate anterior approach is recommended. There are many factors to consider in determining whether to use anterior-only or combined anterior and posterior techniques in the pediatric and adult population. Anterior-only treatment is more likely to apply to a younger, healthier patient with normal bone stock and limited pathology. Patients with large deformities, borderline bone stock, and multisegmental pathologies are more likely to benefit from combined treatment.