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Richard Bransford, Fangyi Zhang, Carlo Bellabarba, Mark Konodi and Jens R. Chapman

extracavitary, transthoracic, and thoracoscopic approaches. 18 For central or paracentral TDH, transthoracic approaches have been favored for some time due to their perceived greater safety in achieving ventral spinal cord decompression. There remain, however, limitations to the anterior transthoracic procedures. In light of this, posterior-based approaches such as transpedicular and transfacet pedicle-sparing techniques have received renewed interest for the treatment of lateral or paracentral TDH due to their more straightforward exposure. 2 , 14 , 26 Previous

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Deanna M. Sasaki-Adams, Jeffrey W. Campbell, Gela Bajelidze, Marcelo C. Assis, William G. Mackenzie and Ann M. Ritter

enlargement of the heart. Initially, an anterior transthoracic approach from T4–9 was undertaken. When the patient was turned prone to complete the posterior approach, the motor evoked potentials decreased significantly. The patient was turned to the right lateral position with a return of the potentials to 80% of baseline. The procedure was aborted. The patient exhibited transient lower-extremity weakness. He returned to the operative arena 5 days later for a posterior decompression from T-3 through T-5 with fusion in the lateral position. Thirty minutes into the procedure

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Daniel C. Lu, Darryl Lau, Jasmine G. Lee and Dean Chou

probability values were performed to evaluate for statistically significant differences. The ASIA scores were assessed on admission and the most recent follow-up; if the patient was lost to follow-up, the last documented ASIA score was used. Anterior Approaches In patients who underwent anterior corpectomies of the thoracolumbar spine, 1 of 3 methods of approach was used. One was a standard transthoracic approach via thoracotomy, with 1 rib removed for exposure and for use as an autograft. The second was a thoracoabdominal approach via low thoracotomy (usually T-10 or

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Eric K. Oermann, Nicholas D. Coppa, Marc Margolis and Faheem A. Sandhu

-total resection of the tumor through a right T9–10 transthoracic approach. Macroscopically, the lesion was a soft, purple, encapsulated, and nodular mass. It was grossly removed without violation of its capsule. The tumor abutted the neural foramen but did not enter the spinal canal. The intercostal nerve was visualized after resection and judged to be intact. Microscopically, the tumor consisted of a series of vascular channels and sinuses with a connective tissue capsule and reticulin-staining matrix. There was an abundance of red pulp with scattered lymphoid nodules and

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Frank S. Bishop, Mical M. Samuelson, Michael A. Finn, Kent N. Bachus, Darrel S. Brodke and Meic H. Schmidt

. Graph showing normalized stiffness in axial rotation. Percentages are compared with the intact spine. Error bars indicate 95% CIs. Discussion Surgical treatment of anterior thoracolumbar spinal disease has been described since 1906 16 and was further pioneered by Hodgson and Stock, 11 who developed a transthoracic approach for the treatment of Pott disease. Early anterior spinal surgery involved no spinal reconstruction, however, and it resulted in progressive deformity from postoperative instability. While initial attempts at anterior spinal stabilization

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Krista Keachie, Kiarash Shahlaie and J. Paul Muizelaar

instability following cervicothoracic junction surgery . J Neurosurg Spine 4 : 278 – 284 , 2006 54 Stillerman CB , Chen TC , Couldwell WT , Zhang W , Weiss MH : Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature . J Neurosurg 88 : 623 – 633 , 1998 55 Vollmer DG , Simmons NE : Transthoracic approaches to thoracic disc herniations . Neurosurg Focus 9 : 4 e8 , 2000 56 Wakefield AE , Steinmetz MP , Benzel EC : Biomechanics of thoracic discectomy . Neurosurg Focus 11 : 3

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Ali Nourbakhsh, Prashant Chittiboina, Prasad Vannemreddy, Anil Nanda and Bharat Guthikonda

.5–25.9 * The even and odd levels were obtained from 2 different sets of cadavers. Abbreviations: T(L) = large thoracic; TL(L) = large thoracolumbar; TL(M) = medium thoracolumbar; TL(S) = small thoracolumbar; T(M) = medium thoracic; T(S) = small thoracic. Discussion Access to the ventral thoracic spine is often required for managing tumors, trauma, and deformity correction. While anterior transthoracic approaches are often poorly tolerated by patients with preexisting cardiopulmonary problems, posterolateral approaches are often more easily tolerated. 7 Several

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Editorial

Spinal deformity

Michael G. Fehlings and George M. Ibrahim

Neurosurgery: Spine , Murans and colleagues 9 report their experience with a large series of 81 patients with complex spine deformities for which correction with a combined anterior-posterior surgical approach between 1997 and 2004 was indicated. Twenty-four of these cases involved an intraspinal pathological entity, necessitating neurosurgical intervention in addition to bone deformity correction. Anterior procedures included retroperitoneal and/or transthoracic approaches, and posterior surgeries consisted of segmental fixation with titanium implants. Neurosurgical

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Girts Murans, Bengt Gustavsson and Helena Saraste

function. During the surgery, prophylactic antibiotics were used. The deformity correction surgery included combined anterior and posterior procedures. The anterior procedure included a retroperitoneal and/or transthoracic approach with no or minimal incision through the diaphragm. Segmental vessels were principally not sacrificed. The anterior fusion included discectomies, autologous rib or bone transplantation from iliac crest, mainly without implants, or with a titanium 1-rod segmental fixation system, which was used in 2 cases. The posterior approach consisted of

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09828 2010.9.SPINE09828 Minimally invasive extracavitary approach for thoracic discectomy and interbody fusion: 1-year clinical and radiographic outcomes in 13 patients compared with a cohort of traditional anterior transthoracic approaches Larry T. Khoo Zachary A. Smith Farbod Asgarzadie Yorgios Barlas Sean S. Armin Vartan Tashjian Baron Zarate 2 2011 14 2 250 260 10.3171/2010.10.SPINE09456 2010.10.SPINE09456 Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy Kaisorn L