The clinical analysis of antero-lateral approaches to thoracic, and lumbar spine pathologies

Introduction: In this study, between 2002-2013, a total of 90 patients underwent antero-lateral surgical approach due to spinal pathologies causing spinal instability, compression, neurological deficits, and pain in thoracic and lumbar regions. The results of the outcomes of anterior approaches were examined in terms of clinical and radiological perspectives Method: Plain x-ray films, magnetic resonance imaging and computed tomography in thin sections were used for the diagnosis. Transthorasic (n=64, 71.1%), retroperitoneal (n=20, 22.2%), and combined (transthorasic+retroperitoneal) approaches (n = 6, 6.7%) were performed in the patients. In the thoraco-lumbar region, in 21 of 48 patients (43.7%), incision of the diaphragm was performed. While the plate-screw-rod fixation system was being used with autogenous grafts to gain bone fusion, in some patient with tumors (n=7), titanium cage was added to this system. Autogenous graft material was placed in the area of the fusion after decompression and then system was locked. Clinical improvement of the patients was evaluated by Frankel scores in pre and postoperative periods. Results: Etiologic factors were classified as trauma (n = 50, 55.6%), spondylodiscitis (n = 15, 15.6 %), tumor (n = 18, 20.0 %), and disc hernia cases (n = 7, 7.8%). Age distribution was 8-80 years (mean 37.8). Female/male ratio was 45/45, and the mean duration of in the follow was 9.4 months (0-72). Fusion rate was 100% and no graft site morbidity was observed. The median preoperative Frankel score was 2.73 (1.24 to 4.22). The score was 3.72 (2.30 to 4.94) in the post-operative period (p < 0.05). Radiological fusion was observed in all patients. As a complication, chylothorax was seen in only 1 patient (morbidity rate: 1.1%) and was treated medically. During postoperative follow period, 1 patient due to pulmonary embolism (postop. 10th day), and 2 patients due to acute myocardial infarction had died (mortality rate: 3.3%). No mortality was observed related to surgical interventions. Conclusion: Surgical procedures for thoracic and lumbar spine pathologies consisting of antero-lateral plate-screw-rod system with autogenous bone graft are the safe and effective surgical techniques because of high fusion rates and good neurological recovery. However, when considering the surgical approach, it must be individualized for each patient in light of clinical and radiological findings. Keywords: Anterolateral Fixation, Fusion, İnstability, Thoracic Region, Lumbar Region