title: Anterior thoracic surgical approaches in the treatment of spinal infections and neoplasms.
abstract: BACKGROUND
  Thoracic surgeons are commonly consulted to provide anterior thoracic exposure for infection and malignant neoplasms involving the thoracolumbar spine. These cases can present significant technical and management challenges secondary to the underlying pathology, associated anatomic inflammation, and impaired functional status. In this study, we review the perioperative outcomes in patients undergoing anterior spinal exposure for infection and neoplasm.
  
  
  METHODS
  130 consecutive patients (61 women, 69 men) undergoing corpectomy, debridement, or debulking for osteomyelitis (n=50) or neoplasms (n=80) with decompression/stabilization at a single institution were analyzed. Primary endpoints included morbidity, mortality, and perioperative neurologic outcomes.
  
  
  RESULTS
  The mean age was 61.1 years. A cervical/sternotomy (n=8) approach was used for levels C7 to T2, thoracotomy (n=79) for levels T3 to T10, and thoracoabdominal (n=43) for T11 to L2 involvement. Primary spinal neoplasms (n=22, 16.9 %) and metastases (n=58, 44.6%) were treated with corpectomy and prosthetic stabilization and were associated with increased operative time (310 vs 243 minutes, p=0.02) and blood loss (825 vs 500 mL, p=0.002). Osteomyelitis was associated with longer hospital stays (12 vs 7 days, p<0.001). The 30-day and 90-day mortality was 9.2% and 20.8%, respectively. The major complication rate was 27.7%. The median length of stay was 9 days. Surgical intervention resulted in significant improvement in pain, numbness, weakness, and bowel and bladder dysfunction.
  
  
  CONCLUSIONS
  Anterior spinal exposure represents an important modality in facilitating the treatment of patients with osteomyelitis, pathologic fractures, and spinal cord compression syndromes. These procedures are associated with a significant risk of morbidity and mortality, but they are effective in achieving spinal stabilization and alleviating neurologic symptoms.
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: schuchertmj@upmc.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Kristen N
authors.initials: KN
authors.lastname: McCormick
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Abbas
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Landreneau
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: James R
authors.initials: JR
authors.lastname: Landreneau
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Andre
authors.initials: A
authors.lastname: Pitanga
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jamilly
authors.initials: J
authors.lastname: Gomes
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Felipè
authors.initials: F
authors.lastname: Franca
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Matthew
authors.initials: M
authors.lastname: El-Kadi
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ferson
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003646:Debridement; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010019:Osteomyelitis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D056888:Patient Positioning / Q000379:methods; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000379:methods; D013125:Spinal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome