RSS-Feed abonnieren
DOI: 10.1055/s-0034-1372431
Minimally Invasive Direct Lateral Approach to the Thoracolumbar Junction: Cadaveric Analysis and Case Illustrations
Publikationsverlauf
10. Mai 2013
30. Dezember 2013
Publikationsdatum:
12. Mai 2014 (online)
![](https://www.thieme-connect.de/media/jnlsa/201501/lookinside/thumbnails/10.1055-s-0034-1372431-1.jpg)
Abstract
Background Multiple surgical exposures to the thoracolumbar junction have been described. The minimally invasive direct lateral approach to the lumbar spine captures the advantages of anterolateral approaches while minimizing soft tissue destruction and perioperative morbidity. Utilizing this approach at the thoracolumbar junction presents unique anatomical challenges posed by the ribs, diaphragm, pleura, and lung.
Methods We examine the use of a minimally invasive direct lateral approach to the thoracolumbar junction (T10–L2) through six cadaveric approaches and provide case examples of three patients.
Results In six approaches with normal spinal alignment we were able to access all disc spaces in the thoracolumbar region. The L2–L3 disc was accessed below the 12th rib in 100% of spines; L1–L2 accessed through the T11–T12 intercostal space in 83% of spines; T12–L1 was accessed through the T11–T12 intercostal space in 67% of spines and through the T10–T11 intercostal space in 33% of spines; T11–T12 was accessed through the T10–T11 intercostal space in 83% of spines; finally, T10–T11 was accessed through the T10–T11 intercostal space in 67% of spines and through the T9–T10 intercostal space in 33% of spines.
Discussion The minimally invasive direct lateral approach offers access to ventral pathology at the thoracolumbar junction. Familiarity with common anatomical structures encountered during this approach in the thoracolumbar junction enhances surgical planning and facilitates surgical exposure.
-
References
- 1 Ikard RW. Methods and complications of anterior exposure of the thoracic and lumbar spine. Arch Surg 2006; 141 (10) 1025-1034
- 2 Bohlman HH, Zdeblick TA. Anterior excision of herniated thoracic discs. J Bone Joint Surg Am 1988; 70 (7) 1038-1047
- 3 Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine 1995; 20 (14) 1592-1599
- 4 Fessler RG, Sturgill M. Review: complications of surgery for thoracic disc disease. Surg Neurol 1998; 49 (6) 609-618
- 5 Regan JJ, Mack MJ, Picetti III GD. A technical report on video-assisted thoracoscopy in thoracic spinal surgery. Preliminary description. Spine 1995; 20 (7) 831-837
- 6 Fessler RG, Sekhar LN. Atlas of Neurosurgical Techniques: Spine and Peripheral Nerves. New York, NY: Thieme; 2006
- 7 Abbott KH, Retter RH. Protrusions of thoracic intervertebral disks. Neurology 1956; 6 (1) 1-10
- 8 Arseni C, Nash F. Thoracic intervertebral disc protrusion: a clinical study. J Neurosurg 1960; 17: 418-430
- 9 Perot Jr PL, Munro DD. Transthoracic removal of midline thoracic disc protrusions causing spinal cord compression. J Neurosurg 1969; 31 (4) 452-458
- 10 Patterson Jr RH, Arbit E. A surgical approach through the pedicle to protruded thoracic discs. J Neurosurg 1978; 48 (5) 768-772
- 11 Uribe JS, Smith WD, Pimenta L , et al. Minimally invasive lateral approach for symptomatic thoracic disc herniation: initial multicenter clinical experience. J Neurosurg Spine 2012; 16 (3) 264-279
- 12 Hulme A. The surgical approach to thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 1960; 23: 133-137
- 13 Maiman DJ, Larson SJ, Luck E, El-Ghatit A. Lateral extracavitary approach to the spine for thoracic disc herniation: report of 23 cases. Neurosurgery 1984; 14 (2) 178-182
- 14 Fessler RG, Dietze Jr DD, Millan MM, Peace D. Lateral parascapular extrapleural approach to the upper thoracic spine. J Neurosurg 1991; 75 (3) 349-355
- 15 McCormick PC. Retropleural approach to the thoracic and thoracolumbar spine. Neurosurgery 1995; 37 (5) 908-914
- 16 Chi JH, Dhall SS, Kanter AS, Mummaneni PV. The Mini-Open transpedicular thoracic discectomy: surgical technique and assessment. Neurosurg Focus 2008; 25 (2) E5
- 17 Uribe JS, Dakwar E, Cardona RF, Vale FL. Minimally invasive lateral retropleural thoracolumbar approach: cadaveric feasibility study and report of 4 clinical cases. Neurosurgery 2011; 68 (1, Suppl Operative): 32-39; discussion 39
- 18 Dakwar E, Ahmadian A, Uribe JS. The anatomical relationship of the diaphragm to the thoracolumbar junction during the minimally invasive lateral extracoelomic (retropleural/retroperitoneal) approach. J Neurosurg Spine 2012; 16 (4) 359-364
- 19 Kim M, Nolan P, Finkelstein JA. Evaluation of 11th rib extrapleural-retroperitoneal approach to the thoracolumbar junction. Technical note. J Neurosurg 2000; 93 (1, Suppl): 168-174
- 20 Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 2006; 6 (4) 435-443
- 21 Uribe JS, Arredondo N, Dakwar E, Vale FL. Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. J Neurosurg Spine 2010; 13 (2) 260-266
- 22 Dakwar E, Cardona RF, Smith DA, Uribe JS. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 2010; 28 (3) E8
- 23 Berjano P, Balsano M, Buric J, Petruzzi M, Lamartina C. Direct lateral access lumbar and thoracolumbar fusion: preliminary results. Eur Spine J 2012; 21 (Suppl. 01) S37-S4
- 24 Baaj AA, Dakwar E, Le TV , et al. Complications of the mini-open anterolateral approach to the thoracolumbar spine. J Clin Neurosci 2012; 19 (9) 1265-1267