title: Lateral extracavitary, costotransversectomy, and transthoracic thoracotomy approaches to the thoracic spine: review of techniques and complications.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  The authors review complications, as reported in the literature, associated with ventral and posterolateral approaches to the thoracic spine.
  
  
  BACKGROUND
  The lateral extracavitary, costotransversectomy, and transthoracic thoracotomy techniques allow surgeons to access the ventral thoracic spine for a wide range of spinal disorders including tumor, degeneration, trauma, and infection. Although the transthoracic thoracotomy has been used traditionally to reach the ventral thoracic spine when access to the vertebral body is required, modifications to the various dorsal approaches have enabled surgeons to achieve goals of decompression, reconstruction, and stabilization through a single approach.
  
  
  METHODS
  A systematic Medline search from 1991 to 2011 was performed to identify series reporting clinical data related to these surgical approaches. The morbidity associated with each approach is reviewed and strategies for complications avoidance are discussed.
  
  
  RESULTS
  Four thousand six hundred seventy-seven articles that assessed outcomes of the approaches to the thoracic spine were identified; of these 31 studies that consisted of 774 patients were selected for inclusion. A mean complication rate of 39%, 17%, and 15% for thoracotomy, lateral extracavitary, and costotransversectomy, respectively, was determined. The thoracotomy approach had the highest reoperation (3.5%) and mortality rates (1.5%). The specific complications and neurological outcomes were categorized.
  
  
  CONCLUSIONS
  Outcomes of the surgical approaches to the thoracic spine have been reported with great detail in the literature. There are limited studies comparing the respective advantages and disadvantages and the differences in technique and outcome between these approaches. The present review suggests that in contrast to the historical experience of the laminectomy for thoracic spine disorders, these alternative approaches are safe and rarely associated with neurological deterioration. The differences between these approaches are based on their complication profiles. A thorough understanding of the regional anatomy will help avoid approach-related complications.
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.forename: Kalil G
authors.initials: KG
authors.lastname: Abdullah
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
authors.forename: Frank
authors.initials: F
authors.lastname: Masters
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
authors.forename: John H
authors.initials: JH
authors.lastname: Shin
mesh_terms: D015984:Causality; D015897:Comorbidity; D006801:Humans; D015994:Incidence; D007796:Laminectomy / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D018570:Risk Assessment; D013118:Spinal Cord Diseases / Q000401:mortality*; D013122:Spinal Diseases / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D013904:Thoracic Vertebrae / Q000601:surgery*; D013908:Thoracotomy / Q000401:mortality*