Refinements to the simultaneous anterior-posterior approach to the thoracolumbar spine

Technical note

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The treatment of complex thoracolumbar disorders occasionally requires combined anterior and posterior approaches. Traditionally, these are either sequentially staged to occur during the same anesthesia procedure or alternatively performed on separate days. A less common option is the simultaneous anterior-posterior approach. The authors discuss the rationale for this approach in selected cases and illustrate a number of modifications to previous descriptions of the procedure. By slightly altering the incision, the risk of wound breakdown and infection has been reduced. The use of newly available positioning devices has allowed easy incorporation of fluoroscopy to guide the placement of spinal instrumentation. The authors have also expanded the use of the approach beyond the original oncological indications to include trauma and infection.

Article Information

Address correspondence to: Daryl R. Fourney, M.D., Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8. email: daryl.fourney@saskatoonhealthregion.ca.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 2. Sagittal (upper) and axial (lower) Gd-enhanced T1-weighted MR images demonstrating T7–8 discitis/osteomyelitis with ventral spinal cord compression due to tuberculosis. The patient had undergone a prior laminectomy.

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    Case 2. Postoperative lateral (left) and anteroposterior (right) radiographs showing the final construct, with a cage at T7–8 and T5–10 stabilization.

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    Case 1. Posterior (upper) and anterior (lower) photographs of a patient in the left lateral decubitus position on the Maximum Access Lateral Table with appropriate padding and security straps.

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    Photograph obtained during a table turning test on the Maximum Access Lateral Table. The test is performed prior to draping to ensure secure prone positioning.

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    Case 1. Photograph depicting the planned incisions marked for the simultaneous, combined exposure. Note how the incisions do not intersect to promote maximal healing.

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    Postoperative lateral (left) and anteroposterior (right) radiographs demonstrating the limitations of instrumentation placement in a patient who remained in the left lateral decubitus position for the entire surgery. The pedicle screws are excessively medial on the left and lateral on the right (the opposite is true for the right lateral decubitus position). A slight scoliosis is present because of the natural curve of the spine in the lateral decubitus position. Hooks are often used instead of pedicle screws, especially for high thoracic levels because intraoperative lateral fluoroscopy is not possible.

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