[Rationale and complications of the anterior-lateral extrapleural retroperitoneal approach for unstable thoracolumbar fractures: Experience in 86 consecutive patients].
OBJECTIVE
To describe the rationale, pros and cons, and complications of the anterior-lateral extrapleural retroperitoneal approach for unstable (TLICS>4) thoracolumbar fractures.


METHODS
Clinical and radiological data and outcomes from a cohort treated surgically via said approach were retrospectively reviewed. All patients were operated on exclusively by 5 neurosurgeons trained in spine surgery.


RESULTS
Between June 1999 and December 2015, 86 patients underwent surgery (median age 42years, most common level: L1). Approximately 32.5% presented with a preoperative neurological defect. After surgery (mean duration: 275minutes), 75.6% presented with no neurological sequelae and only one-third required blood transfusion. Median postoperative stay was 7days. Correction of kyphosis was considered adequate and suboptimal but acceptable in 91% and 9% of the patients, respectively. Complications occurred in 36 patients, the majority being transient. We observed failure of the construct in 2 cases (collapse of an expandable cage and extrusion of a locking screw). No infections, vascular or visceral lesions, permanent neurological worsening or mortality occurred during hospitalisation. One patient ultimately needed additional posterior fixation due to persistence of pain. Median follow-up was 252days (27.9% was lost to follow-up).


CONCLUSIONS
The extrapleural extraperitoneal approach provides solid anterior reconstruction, allows wide decompression of the spinal canal, and permits adequate and long-lasting correction of kyphosis. The rates of infection, construct failure, need for reoperation and vascular or visceral lesions are minimal.
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España. Electronic address: pedrodl@yahoo.com.
Pedro David
PD
Delgado-López
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
Antonio
A
Rodríguez-Salazar
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
Vicente
V
Martín-Velasco
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
Javier
J
Martín-Alonso
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
José Manuel
JM
Castilla-Díez
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
Ana
A
Galacho-Harriero
Servicio de Neurofisiología Clínica, Hospital Universitario de Burgos, Burgos, España.
Elena
E
Araús-Galdós
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery; D035422:Pleural Cavity; D011183:Postoperative Complications / Q000209:etiology*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery*; D055815:Young Adult
Abordaje anterior; Abordaje extrapleural; Anterior approach; Cifosis; Complicaciones; Complications; Extrapleural approach; Fractura toracolumbar; Kyphosis; TLICS; TLICSS; Thoracolumbar fracture