Abstract
Objectives: One of the challenges of spine surgery is the need for adequate exposure of the anterolateral spinal column. Improved retractor systems with integrated lighting minimize the need for large thoracotomy, flank, or abdominal incisions. In 2013, we began using the NuVasive MaXcess® system via a minimal-access lateral incision for thoracic and thoracolumbar spine exposures. These small-access approaches may not offer adequate exposure when bleeding and other complications arise. We sought to determine the feasibility and outcomes of a minimal-access retractor during anterolateral spine exposures. Methods: An institutional-review-board-approved retrospective chart review was performed of all patients who underwent anterolateral thoracic and lumbosacral spine exposure at an academic hospital between December 1999 and April 2017. Cervical and posterior spine exposures were not included. Information regarding patient demographics, comorbid conditions, operative techniques, exposure, estimated blood loss, length of stay, and intraoperative and postoperative complications was collected. Data for standard exposure vs. minimally invasive exposures were compared. Results: Between December 1999 and April 2017, 223 anterolateral spinal exposures were performed at our institution. Of those, 122 (54.7%) patients had true lateral exposures, with 22 (18%) using the minimally invasive retractor. The mean age of our patient population was 57 years (19–89), with 65 (53%) men and a mean body mass index of 29.0 (17.4–58.6). In the standard exposure group, complications occurred in 22 (22%) patients, whereas only two (9%) complications occurred in the minimal-access group. There were no significant differences in overall intraoperative and postoperative complications, except for cardiopulmonary complications, which were reduced in the minimally invasive group (p < 0.019). Patients with minimally invasive exposure had a significantly shorter length of stay than those with standard exposure (7 vs. 13 days, p = 0.001). Conclusions: Minimal-access techniques using advanced retractor systems are both feasible and safe compared to standard techniques allowing for similar lateral spine exposure, but with smaller incisions, fewer cardiopulmonary complications, and shorter lengths of stay.
Highlights
One of the challenges of spine surgery is the need for adequate exposure of the anterolateral spinal column
Standard exposures to the thoracolumbar spine were defined as operations conducted through a traditional lateral exposure with thoracotomy, flank, or retroperitoneal incisions
The results of this study indicated that the minimally invasive retractor is versatile enough to provide adequate exposure for various indications and procedures
Summary
One of the challenges of spine surgery is the need for adequate exposure of the anterolateral spinal column. Access to the lumbar spine is traditionally accomplished with anterior transperitoneal or extraperitoneal approaches, and access to the thoracic spine requires intrapleural, extrapleural, or transdiaphragmatic thoracotomies. These exposures require large incisions, extensive retraction of soft tissue, solid organs, and major vascular structures, and are accompanied by various complications [1,2]. A direct lateral approach to the spinal column allowed for equivalent access and fewer potential complications associated with traditional approaches These exposures were further advanced with specialized retractors that allowed these approaches to be performed with incisions no larger than 3–4 cm [3]
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