Posterolateral Approach for Ventral or Ventrolateral Thoracolumbar Lesion

ABSTRACT

OBJECTIVES: There are various surgical strategies for the treatment of ventral or ventrolateral thoracic or thoracolumbar pathologies. Standard laminectomy with manipulation of the spinal cord can cause significant spinal cord injury. Transthoracic approach requires violation of pleural space, manipulation of the lungs and mediastinal structures, and chest tube drainage. We evaluated the availability of posterolateral approach for ventral or ventrolateral thoracic and thoracolumbar lesion. PATIENTS AND METHODS: We have performed posterolateral approach for 3 years for ventral or ventrolateral thoracic and thoracolumbar lesion in 22 patients; 6 tumor cases, 7 thoracic disc herniation cases and 9 fracture cases. We have performed 16 cases of transpedicular approach, 2 cases of costotransversectomy, 3 cases of lateral extracavitary approach and 1 case of lateral parascapular extrapleural approach. Bilateral transpedicular routes were used in 3 patients and supplemental laminectomies in 6. RESULTS: The final outcome was measured by Prolo's Functional-Economic Outcome Rating Scale. Final functional outcomes were; good in 13, moderate in 6, and poor in 3 cases. Spinal canal decompression was confirmed with follow up CT scan or MRI. There were three operative complications-two CSF leakages and one delayed wound infection. CONCLUSION: Compared to transthoracic approach, the posterolateral approach has few potential complications such as violation of the pleural space, manipulation of the mediastinal structure, and it enables immediate posterior stabilization, if necessary. In conclusion, the posterolateral approach to ventral or ventrolateral thoracolumbar pathology is an effective procedure which allows adequate decompression of ventral encroachment without further spinal cord injury.