56 Open Anterior Spinal Surgery in Adult Spinal Deformities

Anton Jorgensen and Robert W. Gaines

Abstract

The anterior approach for lumbar and thoracolumbar spinal pathology allows direct access to pathologic vertebral body lesions and fractures and provides releases to scoliotic deformities, improving deformity correction and arthrodesis. Typically, the thoracic spine is approached from the right chest (left lateral decubitus position) and the thoracolumbar and upper lumbar spine is approached from the left side (right lateral decubitus or oblique position). However, many lesions can be addressed from either left or right side. Despite advancements inc the minimal invasive approaches to the anterior spine, knowledge of these open anterior spinal approaches can provide valuable options for the spinal deformity surgeon.

Schlüsselwörter

anterior spine surgery - vertebral osteomyelitis - burst fractures - retroperitoneal approach - anterior release - anterior column support

• 1 Dimar II JR, Carreon LY. Anterior spine surgery for the treatment of complex spine pathology: a state-of-the-art review.. Spine Deform 2022; 10 (5) 973-989 PubMed

• 2 Gaines RW, Mehta JS. Anterior Operative Management for Spinal Pathologies. Accessed December 29, 2018 at: http://etext.srs.org/book/

• 3 Mehta JS, Bhojraj SY. Tuberculosis of the thoracic spine: a classification based on the selection of surgical strategies.. Journal of Bone 2001; 83 (6) 859-863 PubMed

• 4 McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures.. Spine 1994; 19 (15) 1741-1744 PubMed

• 5 Dai L-Y, Jiang L-S, Jiang S-D. Anterior-only stabilization using plating with bone structural autograft versus titanium mesh cages for two- or three-column thoracolumbar burst fractures: a prospective randomized study.. Spine 2009; 34 (14) 1429-1435 PubMed

• 6 Gaines RW, Humphreys WG. A plea for judgment in management of thoracolumbar fractures and fracture-dislocations. A reassessment of surgical indications.. Clin Orthop Relat Res 1984; (189) 36-42 PubMed

• 7 Siegal T, Siegal T, Robin G, Lubetzki-Korn I, Fuks Z. Anterior decompression of the spine for metastatic epidural cord compression: a promising avenue of therapy?. Ann Neurol 1982; 11 (1) 28-34 PubMed

• 8 Harrington KD. Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy.. Clin Orthop Relat Res 1988; (233) 177-197 PubMed

• 9 Tanaka M, Nakahara S, Ito Y et al. Surgical treatment of metastatic vertebral tumors.. Acta Med Okayama 2009; 63 (3) 145-150 PubMed

• 10 D’Aliberti G, Talamonti G, Villa F et al. Anterior approach to thoracic and lumbar spine lesions: results in 145 consecutive cases.. J Neurosurg Spine 2008; 9 (5) 466-482 PubMed

• 11 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. Suppl Operative) 32-39, discussion 39 PubMed

• 12 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 PubMed

• 13 Dewald CJ, Millikan KW, Hammerberg KW, Doolas A, Dewald RL. An open, minimally invasive approach to the lumbar spine.. Am Surg 1999; 65 (1) 61-68 PubMed

• 14 Jagannathan J, Chankaew E, Urban P et al. Cosmetic and functional outcomes following paramedian and anterolateral retroperitoneal access in anterior lumbar spine surgery.. J Neurosurg Spine 2008; 9 (5) 454-465 PubMed

• 15 Kim KT, Jo DJ, Lee SH, Seo EM. Oblique retroperitoneal approach for lumbar interbody fusion from L1 to S1 in adult spinal deformity.. Neurosurg Rev 2018; 41 (1) 355-363 PubMed

• 16 Molloy S, Butler JS, Benton A, Malhotra K, Selvadurai S, Agu O. A new extensile anterolateral retroperitoneal approach for lumbar interbody fusion from L1 to S1: a prospective series with clinical outcomes.. Spine J 2016; 16 (6) 786-791 PubMed

• 17 Gumbs AA, Shah RV, Yue JJ, Sumpio B. The open anterior paramedian retroperitoneal approach for spine procedures.. Arch Surg 2005; 140 (4) 339-343 PubMed

• 18 Gumbs AA, Bloom ND, Bitan FD, Hanan SH. Open anterior approaches for lumbar spine procedures.. Am J Surg 2007; 194 (1) 98-102 PubMed

• 19 Kim M-K, Kwak D-S, Jeun S-S et al. Changes in abdominal vascular tension associated with various leg positions in the anterior lumbar approach: cadaver study.. Spine 2010; 35 (10) 1026-1032 PubMed

• 20 Benglis DM, Elhammady MS, Levi AD, Vanni S. Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity.. Neurosurgery 2008; 63 (3) (Suppl. Suppl) 191-196 PubMed

• 21 Benglis DM, Vanni S, Levi AD. An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine.. J Neurosurg Spine 2009; 10 (2) 139-144 PubMed

• 22 Tannoury C, Das A, Saade A, Bhale R, Chen K, Tannoury T. The Antepsoas (ATP) surgical corridor for lumbar and lumbosacral arthrodesis: a radiographic, anatomic, and surgical investigation.. Spine 2022; 47 (15) 1084-1092 PubMed

• 23 Silvestre C, Mac-Thiong JM, Hilmi R, Roussouly P. Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients.. Asian Spine J 2012; 6 (2) 89-97 PubMed

• 24 Cunningham BW, Polly Jr DW. The use of interbody cage devices for spinal deformity: a biomechanical perspective.. Clin Orthop Relat Res 2002; 394 (394) 73-83 PubMed

• 25 Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis.. Spine 2005; 30 (6) 682-688 PubMed

• 26 Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity.. Spine 2005; 30 (18) 2024-2029 PubMed

• 27 Hodgson AR, Stock FE, Fang HS, Ong GB. Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott’s disease of the spine.. Br J Surg 1960; 48: 172-178 PubMed

• 28 Singh K, DeWald CJ, Hammerberg KW, DeWald RL. Long structural allografts in the treatment of anterior spinal column defects.. Clin Orthop Relat Res 2002; (394) 121-129 PubMed

• 29 D’Aliberti G, Talamonti G, Villa F, Debernardi A. The anterior stand-alone approach (ASAA) during the acute phase of spondylodiscitis: results in 40 consecutively treated patients.. Eur Spine J 2012; 21 (Suppl. Suppl 1) S75-S82 PubMed

• 30 Dai L-Y, Jin W-J. Interobserver and intraobserver reliability in the load sharing classification of the assessment of thoracolumbar burst fractures.. Spine 2005; 30 (3) 354-358 PubMed

• 31 Wang X-Y, Dai L-Y, Xu H-Z, Chi Y-L. The load-sharing classification of thoracolumbar fractures: an in vitro biomechanical validation.. Spine 2007; 32 (11) 1214-1219 PubMed

• 32 Kaneda K, Abumi K, Fujiya M. Burst fractures with neurologic deficits of the thoracolumbar-lumbar spine. Results of anterior decompression and stabilization with anterior instrumentation.. Spine 1984; 9 (8) 788-795 PubMed

• 33 Ghanayem AJ, Zdeblick TA. Anterior instrumentation in the management of thoracolumbar burst fractures.. Clin Orthop Relat Res 1997; (335) 89-100 PubMed

• 34 Dai L-Y, Jiang L-S, Jiang S-D. Conservative treatment of thoracolumbar burst fractures: a long-term follow-up results with special reference to the load sharing classification.. Spine 2008; 33 (23) 2536-2544 PubMed

• 35 Kostuik JP. Anterior spinal cord decompression for lesions of the thoracic and lumbar spine, techniques, new methods of internal fixation results.. Spine 1983; 8 (5) 512-531 PubMed

• 36 Johnson JR, Leatherman KD, Holt RT. Anterior decompression of the spinal cord for neurological deficit.. Spine 1983; 8 (4) 396-405 PubMed

• 37 Nguyen HV, Akbarnia BA, van Dam BE et al. Anterior exposure of the spine for removal of lumbar interbody devices and implants.. Spine 2006; 31 (21) 2449-2453 PubMed

• 38 Kostuik JP. Anterior fixation for burst fractures of the thoracic and lumbar spine with or without neurological involvement.. Spine 1988; 13 (3) 286-293 PubMed

• 39 McDonough PW, Davis R, Tribus C, Zdeblick TA. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation.. Spine 2004; 29 (17) 1901-1908, discussion 1909 PubMed

• 40 Kim Y-J, Otsuka NY, Flynn JM, Hall JE, Emans JB, Hresko MT. Surgical treatment of congenital kyphosis.. Spine 2001; 26 (20) 2251-2257 PubMed

• 41 An HS, Lim TH, You JW, Hong JH, Eck J, McGrady L. Biomechanical evaluation of anterior thoracolumbar spinal instrumentation.. Spine 1995; 20 (18) 1979-1983 PubMed

• 42 Knop C, Lange U, Bastian L, Oeser M, Blauth M. Biomechanical compression tests with a new implant for thoracolumbar vertebral body replacement.. Eur Spine J 2001; 10 (1) 30-37 PubMed

• 43 Reinhold M, Schmoelz W, Canto F, Krappinger D, Blauth M, Knop C. A new distractable implant for vertebral body replacement: biomechanical testing of four implants for the thoracolumbar spine.. Arch Orthop Trauma Surg 2009; 129 (10) 1375-1382 PubMed

• 44 Bone LB, Johnston II CE, Ashman RB, Roach JW. Mechanical comparison of anterior spinal instrumentation in a burst fracture model.. J Orthop Trauma 1988; 2 (3) 195-201 PubMed

• 45 Cripton PA, Jain GM, Wittenberg RH, Nolte LP. Load-sharing characteristics of stabilized lumbar spine segments.. Spine 2000; 25 (2) 170-179 PubMed

• 46 Dick JC, Brodke DS, Zdeblick TA, Bartel BD, Kunz DN, Rapoff AJ. Anterior instrumentation of the thoracolumbar spine. A biomechanical comparison.. Spine 1997; 22 (7) 744-750 PubMed

• 47 Chang U-K, Lim J, Kim DH. Biomechanical study of thoracolumbar junction fixation devices with different diameter dual-rod systems.. J Neurosurg Spine 2006; 4 (3) 206-212 PubMed

• 48 Chou D, Larios AE, Chamberlain RH et al. A biomechanical comparison of three anterior thoracolumbar implants after corpectomy: are two screws better than one?. J Neurosurg Spine 2006; 4 (3) 213-218 PubMed

• 49 Fricka KB, Mahar AT, Newton PO. Biomechanical analysis of anterior scoliosis instrumentation: differences between single and dual rod systems with and without interbody structural support.. Spine 2002; 27 (7) 702-706 PubMed

• 50 Brodner W, Mun Yue W, Möller HB, Hendricks KJ, Burd TA, Gaines RW. Short segment bone-on-bone instrumentation for single curve idiopathic scoliosis.. Spine 2003; 28 (20) (Suppl. 20S) S224-S233 PubMed

• 51 Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries.. Spine 1983; 8 (8) 817-831 PubMed

• 52 Flamme CH, von der Heide N, Heymann C, Hurschler C. Primary stability of anterior lumbar stabilization: interdependence of implant type and endplate retention or removal.. Eur Spine J 2006; 15 (6) 807-818 PubMed

• 53 Faro FD, Farnsworth CL, Shapiro GS et al. Thoracic vertebral screw impingement on the aorta in an in vivo bovine model.. Spine 2005; 30 (21) 2406-2413 PubMed

• 54 Bullmann V, Fallenberg EM, Meier N et al. The position of the aorta relative to the spine before and after anterior instrumentation in right thoracic scoliosis.. Spine 2006; 31 (15) 1706-1713 PubMed

• 55 Huitema GC, Cornips EM, Castelijns MH, van Ooij A, van Santbrink H, van Rhijn LW. The position of the aorta relative to the spine: is it mobile or not? Spine 2007; 32(12):1259-1264

• 56 Maruyama T, Takeshita K, Nakamura K, Kitagawa T. Spatial relations between the vertebral body and the thoracic aorta in adolescent idiopathic scoliosis.. Spine 2004; 29 (18) 2067-2069 PubMed

• 57 Huitema GC, van Rhijn LW, van Ooij A. Screw position after double-rod anterior spinal fusion in idiopathic scoliosis: an evaluation using computerized tomography.. Spine 2006; 31 (15) 1734-1739 PubMed

• 58 Sevuk U, Mesut A, Kiraz I, Kose K, Ayaz F, Erkul A. Delayed presentation of aortic injury by a thoracic pedicle screw.. J Card Surg 2016; 31 (4) 220-230 PubMed

• 59 Matsuzaki H, Tokuhashi Y, Wakabayashi K, Kitamura S. Penetration of a screw into the thoracic aorta in anterior spinal instrumentation. A case report.. Spine 1993; 18 (15) 2327-2331 PubMed

• 60 Freyrie A, Gasbarrini A, Simoes CE, Gallitto E, Gargiulo M. Delayed presentation of a thoracic aortic injury with a vertebral pedicle screw.. Ann Vasc Surg 2013; 27 (4) 499.e1-499.e3 PubMed

• 61 Quraishi NA, Konig M, Booker SJ et al. Access related complications in anterior lumbar surgery performed by spinal surgeons.. Eur Spine J 2013; 22 (Suppl 1) S16-S20 PubMed