title: The lateral extracavitary approach to the thoracolumbar spine: a case series and systematic review.
abstract: OBJECTIVE
  Since its introduction in 1976, the lateral extracavitary approach (LECA) has been used to access ventral and ventrolateral pathology affecting the thoracolumbar spine. Reporting of outcomes and complications has been inconsistent. A case series and systematic review are presented to summarize the available data.
  
  
  METHODS
  A retrospective review of medical records was performed, which identified 65 consecutive patients who underwent LECA for the treatment of thoracolumbar spine and spinal cord pathology. Cases were divided according to the presenting pathology. Neurological outcomes and complications were detailed. In addition, a systematic review of outcomes and complications in patients treated with the LECA as reported in the literature was completed.
  
  
  RESULTS
  Sixty-five patients underwent the LECA to the spine for the treatment of thoracic spine and spinal cord pathology. The most common indication for surgery was thoracic disc herniation (23/65, 35.4%). Neurological outcomes were excellent: 69.2% improved, 29.2% experienced no change, and 1.5% were worse. Two patients (3.1%) experienced a complication. The systematic review revealed comparable neurological outcomes (74.9% improved) but a notably higher complication rate (32.2%).
  
  
  CONCLUSIONS
  The LECA provides dorsal and unilateral ventrolateral access to and exposure of the thoracolumbar spine and spinal cord while allowing for posterior instrumentation through the same incision. Although excellent neurological results can be expected, the risk of pulmonary complications should be considered.
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Foreman
authors.affiliation: Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Naftel
authors.affiliation: Anesthesia, University of Alabama at Birmingham, Alabama; and.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Moore
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Mark N
authors.initials: MN
authors.lastname: Hadley
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome
keywords: ASIA = American Spinal Injury Association; DVT = deep venous thrombosis; JOA = Japanese Orthopaedic Association; LECA = lateral extracavitary approach; complication; lateral extracavitary approach; outcome; thoracic spinal cord; thoracic spine