Anterloateral Approach Combined with Modified Posterolateral Approach for a Lesion of the Thoracic or Upper Lumbar Region

ABSTRACT

During recent 3 years, 10 patients with epidural cord compression from a lesion in the anterior portion of the thoracic or upper lumbar area have been treated surgically by an anterolateral approach combined with modified posterolateral approach for decompression. Of 10 patient-two cases of OPLL(ossification of posterior longitudinal ligament) with herniated disc, two cases of metastatic tumor, one case of neurilemmoma, one case of pyogenic osteomyelitis of the vertebral body, two cases of herniated disc, one case of traumatic fracture-dislocation, and one case of congenital hemivertebra-5 patients with mild paraparesis improved postoperatively and returned to normal neurologically, 4 patients with moderate gait disturbance were ambulatory without any device, and one completely paraplegic patient was able to walk with device at 1 year after the operation. This approach could be used for removal of disc material, transverse process, lamina, or pedicle through one stage operation. This point is an advantage of this method compared to postero-lateral approach, lateral approach, or anterolateral approach. Anterior decompression by a modified anterolateral approach should be considered for management of spinal cord compressions such as tumor, infective lesion, traumatic lesion, or congenital malformation.