Lateral extracavitary approach to the thoracic and thoracolumbar spine.

Twenty-nine patients with anterior spinal cord compression underwent decompression and fusion through a laterally based approach to the thoracic and thoracolumbar spine. The lateral extracavitary approach allows access to the vertebral bodies as well as the posterior elements through a single incision. This approach was chosen for patients who had complicating medical conditions that made staged procedures less desirable. Ten men and 19 women with an average age of 53 years were studied. Diagnoses included post-traumatic deformity, metastatic disease, osteomyelitis, and primary neoplasms. Twenty-three patients had frank neurologic loss preoperatively, and 28 patients had significant medical comorbidities as evidenced by American Society of Anesthesiology classes II, III, and IV. One patient died postoperatively from pneumonia, which developed in a lung with metastatic disease, and two patients developed seromas that subsequently became infected. The average intensive care unit stay was less than 2 days. Patients remained intubated for an average of 13 hours after surgery. In this population of medically compromised patients with difficult spinal disease, the lateral extracavitary approach provided an effective means of one-stage treatment. Patients tolerated the procedure, and cardiopulmonary complications were minimal. This approach is most appropriate in patients who require posterior stabilization in conjunction with anterior stabilization.