Methods and complications of anterior exposure of the thoracic and lumbar spine.
OBJECTIVE
To review the methods and complications of exposing the anterior aspects of the thoracic and lumbosacral spine.


METHODS
PubMed (journals database of the National Library of Medicine), text books, the University HealthSystem Consortium Clinical Process Improvement Benchmarking Project, a newspaper, and the US government Healthcare Cost and Utilization Project.


METHODS
Descriptions of morbidity and mortality specifically related to anterior spine exposure depicted in both case reports and clinical series were used.


METHODS
Mortality data from clinical series with more than 30 cases were tabulated. Morbidity incidences were described.


RESULTS
The frequency of anterior exposure of the spine for structural operations is steadily increasing. Both thoracic and lumbosacral anterior spine operations are associated with exposure-related complication rates of 10% to 50%. Pulmonary complications are frequent after thoracic exposures. Chylothorax is the most common of several rarer chest-exposure complications. Vascular complications, particularly arterial thrombosis (<1% of cases) and venous bleeding (2%-15% of cases), are the most frequent complications at the lumbar level. Other lumbosacral exposure complications include ureteral and nerve (somatic and sympathetic) injury. The mortality rate in anterior spine exposures is less than 1%.


CONCLUSIONS
The exposure portions of anterior spine operations result in numerous complications. There are fewer reported complications with endoscopic exposures of the anterior spine than with open exposures, although endoscopic exposures have been used for less complicated cases. In comparable cases, neither exposure nor results of endoscopic operations have proven better than operations done through minilaparotomy incisions. Perioperative cooperation between exposing and spine surgeons is necessary to enhance results in anterior spine operations.
Ikard
Robert W
RW
Department of Surgery, Vanderbilt University, Nashville, Tenn. 37205, USA. bnkikard@comcast.net
D004724:Endoscopy; D006801:Humans; D008159:Lumbar Vertebrae; D009017:Morbidity; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods*; D020760:Spinal Cord Ischemia / Q000209:etiology; D013122:Spinal Diseases / Q000601:surgery*; D013904:Thoracic Vertebrae; D013908:Thoracotomy