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Open Anterior Approach to the Middle and Lower Thoracic Spine

March 01, 2019

Contributors: Jocelyn T Compton, MD, MSc; Piyush Kalakoti, MBBS, MD; Luca Labianca, MD; Stuart L Weinstein, MD; Kazuta Yamashita, MD; Cosma Calderaro, MD; Cosma Calderaro, MD

2019 AWARD WINNER Severe spine deformities often require correction in multiple planes. Although posterior correction with pedicle screws is commonly used for the management of scoliosis, anterior release of the anterior longitudinal ligament and the anulus fibrosus and the removal of disk material with exposure of the vertebral end plate may be an adjunctive procedure necessary for the management of severe and rigid scoliosis or kyphosis. The thoracoscopic approach is advantageous over the open thoracotomy approach because it is associated with decreased risk of surgical injury, decreased postoperative pain, and decreased hospitalization (in the absence of a posterior approach). However, the thoracoscopic approach is technically demanding, associated with a substantial learning curve, and may afford insufficient visualization. In addition, the chest cavity in young children is small with limited rib spacing, and the increased vascularity of the vertebral bodies may create bleeding problems. Knowledge of the thoracotomy approach to the middle and lower thoracic spine, which is a safe adjunctive procedure for the management of severe structural spine deformities, may help overcome these problems.

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