title: Cosmetic and functional outcomes following paramedian and anterolateral retroperitoneal access in anterior lumbar spine surgery.
abstract: OBJECTIVE
  In this paper, the authors review the functional and cosmetic outcomes and complications in 300 patients who underwent treatment for lumbar spine disease via either an anterior paramedian or conventional anterolateral retroperitoneal approach.
  
  
  METHODS
  Seven surgeons performed anterior lumbar surgeries in 300 patients between August 2004 and December 2006. One hundred and eighty patients were treated with an anterior paramedian approach, and 120 patients with an anterolateral retroperitoneal approach. An access surgeon was used in 220 cases (74%). Postoperative evaluation in all patients consisted of clinic visits, assessment with the modified Scoliosis Research Society-30 instrument, as well as a specific questionnaire relating to wound appearance and patient satisfaction with the wound.
  
  
  RESULTS
  At a mean follow-up of 31 months (range 12-47 months), the mean Scoliosis Research Society-30 score (out of 25) was 21.2 in the patients who had undergone the anterior paramedian approach and 19.4 in those who had undergone the anterolateral retroperitoneal approach (p = 0.005). The largest differences in quality of life measures were observed in the areas of pain control (p = 0.001), self-image (p = 0.004), and functional activity (p = 0.003), with the anterior paramedian group having higher scores in all 3 categories. Abdominal bulging in the vicinity of the surgical site was the most common wound complication observed and was reported by 22 patients in the anterolateral retroperitoneal group (18%), and 2 patients (1.1%) in the anterior paramedian group. Exposures of >or= 3 levels with the anterolateral approach were associated with abdominal bulging (p = 0.04), while 1- or 2-level exposures were not (p > 0.05). Overall satisfaction with incisional appearance was higher in patients with an anterior paramedian incision (p = 0.001) and with approaches performed by an access surgeon (p = 0.004).
  
  
  CONCLUSIONS
  Patients who undergo an anterior paramedian approach to the lumbar spine have a higher quality of life and better cosmetic outcomes than patients undergoing an anterolateral retroperitoneal approach.
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia 22902, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Jagannathan
authors.forename: Ekawut
authors.initials: E
authors.lastname: Chankaew
authors.forename: Peter
authors.initials: P
authors.lastname: Urban
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sansur
authors.forename: John
authors.initials: J
authors.lastname: Kern
authors.forename: Benjamin
authors.initials: B
authors.lastname: Peeler
authors.forename: W Jeffrey
authors.initials: WJ
authors.lastname: Elias
authors.forename: Francis
authors.initials: F
authors.lastname: Shen
authors.forename: Mark E
authors.initials: ME
authors.lastname: Shaffrey
authors.forename: Richard
authors.initials: R
authors.lastname: Whitehill
authors.forename: Vincent
authors.initials: V
authors.lastname: Arlet
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D020127:Recovery of Function; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome