Lateral Extracavitary Approach for Thoracic Spine Trauma

OBJECTIVE: The lateral extracavitary approach(LECA) to the thoracic spine is known as one of the procedure which allows direct vision of pathologic lesion, ventral decompression and dorsal fixation of the spine through the same incision. The authors present a usefulness of the LECA to the complicated unstable thoracic spine caused by trauma. METHODS: The authors performed LECA on six patients from January 1999 to June 2001. All patients were male and their age distribution was from 17 to 65 years. Perioperative neurological state, radiological image, and their changes during follow-up period were evaluated in all patients. RESULTS: After operation, neurological symptoms were improved and there were no significant post-operative complications. Among these trauma cases, three patients showed rapid recovery of their impending paraparesis. In two patients with paraplegia from severe fracture-dislocation, only one patient was minimally improved to motor grade 3. Spinal alignments were maintained in all. CONCLUSION: Lateral extracavitary approach is considered to be a alternative method for the treatment of traumatic thoracic vertebra with high grade instability. The major advantage of this approach is that circumferential decompression of the spine and rigid fixation can be obtained throurh the same incision.

Surgical Anatomy of Lateral Extracavitary Approach to the Thoracolumar Spine: Cadaveric Study

OBJECTIVE: The lateral extracavitary approach(LECA) to the thoracolumbar spine is known as one of procedure which allows not only direct vision of pathologic lesion, but also ventral decompression, and dorsal fixation of the spine through the same incision. However, some drawbacks of LECA, including the technically- demanding, time-consuming, unfamiliar surgical anatomy and excessive blood loss, make surgeons to hesitate to use this approach. This study is to provide the surgical anatomy of LECA using cadavers, for detailed informations when LECA is considered for the surgery. METHODS: We performed the 10 cadaveric studies, 7 male and 3 female, and careful dissection was carried out on right side of thoracolumbar region, except one for thoracic region. The photographs with micro-lens were taken to depict the close-up findings and for demonstrating detailed anatomy. RESULTS: The photographs and hand-drawings demonstrated the relationships among the musculature, segmental vessels and nerve roots seen during each dissection plane. The lateral branches of dorsal rami of spinal nerve and the transverse process were confirmed to be the most important landmark of this approach. CONCLUSION: We concluded that detailed anatomical findings for LECA through this step-by-step dissection would be useful during operative intervention to reduce the intraoperative complications in LECA.