Minimally Invasive Extrapleural Retroperitoneal Approach to the Thoracolumbar Spine Junction: ClinicoradiologicStudy of 29 Consecutive Cases

摘要

: The anterior spinal cord decompression and spinal interbody fusion is considered an effective therapeutic procedure for thoracolumbar spine junction (Tl 1 to L2) fractures and tumors. However, it is also known to be associated with considerable surgery-related trauma. The purpose of this study is to show that neural elements decompression and anterior reconstruction at the thoracolumbar spine junction can be conducted through a minimally invasive extrapleural retroperitonal approach (MIERA). Hospital records and radiologic data were obtained prospec-tively in 29 patients (mean age 43.6 years, range 16 to 74 y) who all underwent first a posterior fixation followed by a thoracic (Til or T12) or lumbar (LI or L2) corpectomy and spinal fusion through a MIERA. The MIERA provided excellent exposure to facilitate neural decompression and anterior reconstruction in all patients, as verified on follow-up radio-graphic studies. More than 1-year follow-up record is available for 23 patients, a 9-month follow-up record for 4 others, and 6-months follow-up for the last 3 ones. Radiography showed anatomically correct reconstruction in all patients, and a solid fusion or a stable compound union in the 20 patients for whom a minimum of 1-year follow-up records were available. The MIERA allows the surgeon to carry out anterior thoracolumbar junction spine surgery through a less invasive approach. The investigators report the safety efficacy of this technique and its reduced perioperative morbidity compared with conventional retroperitoneal lumbar spine surgery or thoraco-phreno-lombotomy.