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From the American Academy of Orthopaedic Surgeons

Fracture of the Thoracic and Lumbar Spine

The Spine

Las Fracturas (Fractures)

Anterior Approaches to the Thoracolumbar Spine
by Raj D. Rao, MD; Vaibhav Bagaria, MD;

This topic reviews three anterior approaches to the thoracolumbar spine: thoracotomy, retroperitoneal flank approach, and the pararectus retroperitoneal approach.

Thoracotomy is used to expose vertebral bodies from T3-T12; debride vertebral osteomyelitis or diskitis; for anterior vertebral body tumor excision; for corpectomy for thoracic burst fractures; for thoracic diskectomies or fusion; and for anterior release with or without instrumentation in surgery to correct deformity.

The retroperitoneal flank approach is used for fusions from L1-4 with placement of lateral interbody implants; for debridement of vertebral osteomyelitis or diskitis; for vertebral body tumor excision; for decompression and stabilization in fractures from T12 to L4; and for anterior release and stabilization for scoliosis.

The pararectus retorperitoneal approach is used to expose the anterior aspect of vertebral bodies from L4 to S1; for interbody fusion of L4-5 and L5-S1; for débridement of vertebral osteomyelitis or diskitis; for anterior vertebral body tumor excision; and for anterior release for deformity. It is not considered to be appropriate if there is prior inflammatory or infectious disease in the anatomic region; if there is prior surgery with consequent adhesions or endometriosis, or if exposure of vertebral bodies difficult, even hazardous.

Keywords: indications, vertebral osteomyelitis, vertebral diskitis, anterior vertebral body tumor excision, corpectomy, thoracic burst fractures, diskectomy, fusion anterior release with instrumentation, anterior release without instrumentation, surgical techniques, surgical exposures, retroperitoneal flank approach, pararectus retroperitoneal approach, complications, anatomy

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