title: Anterior corpectomy via the mini-open, extreme lateral, transpsoas approach combined with short-segment posterior fixation for single-level traumatic lumbar burst fractures: analysis of health-related quality of life outcomes and patient satisfaction.
abstract: OBJECTIVE
  The authors present clinical outcome data and satisfaction of patients who underwent minimally invasive vertebral body corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach and posterior short-segment instrumentation for lumbar burst fractures.
  
  
  METHODS
  Patients with unstable lumbar burst fractures who underwent corpectomy and anterior column reconstruction via a mini-open, extreme lateral, transpsoas approach with short-segment posterior fixation were reviewed retrospectively. Demographic information, operative parameters, perioperative radiographic measurements, and complications were analyzed. Patient-reported outcome instruments (Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12]) and an anterior scar-specific patient satisfaction questionnaire were recorded at the latest follow-up.
  
  
  RESULTS
  Twelve patients (7 men, 5 women, average age 42 years, range 22-68 years) met the inclusion criteria. Lumbar corpectomies with anterior column support were performed (L-1, n = 8; L-2, n = 2; L-3, n = 2) and supplemented with short-segment posterior instrumentation (4 open, 8 percutaneous). Four patients had preoperative neurological deficits, all of which improved after surgery. No new neurological complications were noted. The anterior incision on average was 6.4 cm (range 5-8 cm) in length, caused mild pain and disability, and was aesthetically acceptable to the large majority of patients. Three patients required chest tube placement for pleural violation, and 1 patient required reoperation for cage subsidence/hardware failure. Average clinical follow-up was 38 months (range 16-68 months), and average radiographic follow-up was 37 months (range 6-68 months). Preoperative lumbar lordosis and focal lordosis were significantly improved/maintained after surgery. Patients were satisfied with their outcomes, had minimal/moderate disability (average ODI score 20, range 0-52), and had good physical (SF-12 physical component score 41.7% ± 10.4%) and mental health outcomes (SF-12 mental component score 50.2% ± 11.6%) after surgery.
  
  
  CONCLUSIONS
  Anterior corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach supplemented by short-segment posterior instrumentation is a safe, effective alternative to conventional approaches in the treatment of single-level unstable burst fractures and is associated with excellent functional outcomes and patient satisfaction.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Theologis
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Tabaraee
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California.
authors.forename: Paul
authors.initials: P
authors.lastname: Toogood
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California.
authors.forename: Abbey
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California.
authors.forename: Harjus
authors.initials: H
authors.lastname: Birk
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California.
authors.forename: R Trigg
authors.initials: RT
authors.lastname: McClellan
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California.
authors.forename: Murat
authors.initials: M
authors.lastname: Pekmezci
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: ASA = American Society of Anesthesiologists; MCS = mental component score; MIS = minimally invasive surgery; ODI = Oswestry Disability Index; PCS = physical component score; SF-12 = 12-Item Short Form Health Survey; TLICS = Thoracolumbar Injury and Classification Score; burst fractures; clinical outcomes; corpectomy; extreme lateral; lumbar; minimally invasive surgery; transpsoas approach; trauma