title: Lateral extracavitary vs. costotransversectomy approaches to the thoracic spine: reflections on lessons learned.
abstract: BACKGROUND
  The lateral extracavitary approach (LECA) and costotransversectomy (CTE) are 2 dorsolateral approaches that avoid entrance into the pleural cavity and facilitate ventral decompression. The indications and outcomes of each of these approaches have not been fully defined in the literature.
  
  
  OBJECTIVE
  To assess the techniques, indications, and complications associated with the LECA and CTE approaches to the thoracic spine.
  
  
  METHODS
  A retrospective analysis was performed on all patients who underwent LECA and CTE between 2000 and 2009 at our institution.
  
  
  RESULTS
  A total of 54 patient charts were reviewed (19 LECA, 35 CTE). Indications for operation included disk herniation, trauma, tumor, osteomyelitis, and scoliosis/kyphosis. Osteomyelitis was treated significantly more often with LECA (47%) than with CTE (9%; P = .002). Mean blood loss was 2134 mL and 1556 mL (P = .3) in LECA and CTE, respectively, and hospital stay was 17.2 days for LECA and 9.8 days for CTE (P = .07). Thirteen LECA patients (68%) and 19 CTE patients (54%; P = 1.0) had preoperative or postoperative complications.
  
  
  CONCLUSIONS
  LECA was used more often to treat complex pathologies such as osteomyelitis and trended toward significance for more frequent use in extensive procedures involving 1- or 2-level corpectomies. As can be expected, CTE was associated with slightly less blood loss and a shorter hospital stay compared with the more extensive LECA operation. Adverse outcomes occurred with similar frequency for CTE and LECA.
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio 44195, USA. dlubelski@gmail.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.forename: Kalil G
authors.initials: KG
authors.lastname: Abdullah
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
authors.forename: John H
authors.initials: JH
authors.lastname: Shin
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Alvin
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
mesh_terms: D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome