title: Technical challenges and utility of anterior exposure for thoracic spine pathology.
abstract: BACKGROUND
  Thoracic surgeons are frequently called upon to provide exposure to the anterior cervicothoracic, thoracic, and proximal lumbar spine. We reviewed our surgical experience and the perioperative outcomes of these spinal approaches. Relevant technical and anatomic considerations of each procedure are highlighted.
  
  
  METHODS
  A total of 213 patients (116 female, 97 male) undergoing anterior thoracic spinal exposures over an 11-year period at a single institution were analyzed. Primary endpoints include morbidity, mortality, and perioperative outcomes.
  
  
  RESULTS
  Mean age was 53.7 years. Surgical approaches were determined based on the location and length of spinal involvement, and included cervicothoracic (5), thoracotomy (117), and thoracoabdominal (91) techniques. Malignant etiologies were associated with the highest perioperative mortality (6.7%, p = 0.08). Procedures for infection were associated with a significantly higher complication rate (p = 0.041) and length of stay (p = 0.033). Correction of scoliosis required longer operative times (p < 0.001) and resulted in a trend toward higher blood loss (p = 0.16). Thoracoabdominal approaches were associated with increased operative times (386 vs 316 minutes) and length of stay (8 vs 6 days) compared with thoracotomy.
  
  
  CONCLUSIONS
  The increased use of anterior approaches to spinal pathology necessitates greater involvement by thoracic surgeons. Familiarity with the anatomic and technical features of the anterior spinal exposure is required by thoracic surgeons to optimize surgical outcomes.
authors.affiliation: Heart, Lung, and Esophageal Surgery Institute, and Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Pettiford
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.forename: Geetha
authors.initials: G
authors.lastname: Jeyabalan
authors.forename: James R
authors.initials: JR
authors.lastname: Landreneau
authors.forename: Arman
authors.initials: A
authors.lastname: Kilic
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Landreneau
authors.forename: Omar
authors.initials: O
authors.lastname: Awais
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kent
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ferson
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012600:Scoliosis / Q000473:pathology / Q000601:surgery; D013122:Spinal Diseases / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000473:pathology / Q000601:surgery; D013249:Sternum / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult