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Neither drainage nor fusion was adequate from the back. The main impetus for initially approaching the spine anteriorly was to treat Pott's disease. This review addresses incisional techniques ( Table 1) and nonstructural perioperative complications of anterior exposure of the thoracic and lumbar spine. 7 However, complications associated with the exposures for these procedures are less well recognized. Complications of the structural portions of the operations are well known, eg, infection, instability, instrument failure, arachnoiditis, and paralysis. Surgeons providing access to the anterior spine should know the anatomy, understand the structural operations being performed, and anticipate possible complications. Whereas comprehensive technical descriptions of the most frequent procedures are included in spine surgery textbooks, they are not addressed in major general or thoracic surgery texts. Anterior exposures of the thoracic, thoracolumbar, lumbar, and lumbosacral levels are customarily provided by general, thoracic, or vascular cosurgeons (exposing surgeons).
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Neurosurgeons or orthopedists (spine surgeons) usually provide their own anterior exposures for operations on the cervical spine. Although there were fewer thoracic and thoracolumbar cases during that interval, the estimated increase of 304% was even more striking-2102 cases in 1997 6404 in 2002. By 2002, the estimate was 29 583 cases-a 56% increase. According to the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, 1 an estimated 18 982 lumbar and lumbosacral fusions were performed in the United States in 1997. As instrumentation has evolved, the incidence of anterior procedures alone or in combination with posterior ones has rapidly increased. Radiological techniques such as computed tomography, magnetic resonance imaging, and diskography have elucidated spinal structural abnormalities. Perioperative cooperation between exposing and spine surgeons is necessary to enhance results in anterior spine operations.Īnterior exposure of the spinal column provides surgical versatility and therapeutic success often unavailable via the posterior approach alone. In comparable cases, neither exposure nor results of endoscopic operations have proven better than operations done through minilaparotomy incisions. There are fewer reported complications with endoscopic exposures of the anterior spine than with open exposures, although endoscopic exposures have been used for less complicated cases. The mortality rate in anterior spine exposures is less than 1%.Ĭonclusions The exposure portions of anterior spine operations result in numerous complications. Other lumbosacral exposure complications include ureteral and nerve (somatic and sympathetic) injury. Vascular complications, particularly arterial thrombosis (<1% of cases) and venous bleeding (2%-15% of cases), are the most frequent complications at the lumbar level. Chylothorax is the most common of several rarer chest-exposure complications. Pulmonary complications are frequent after thoracic exposures. Both thoracic and lumbosacral anterior spine operations are associated with exposure-related complication rates of 10% to 50%. Morbidity incidences were described.ĭata Synthesis The frequency of anterior exposure of the spine for structural operations is steadily increasing.
GREENFIELD SURGERY TEXTBOOK REFERENCE BIBLIOGRAPHY SERIES
Study Selection Descriptions of morbidity and mortality specifically related to anterior spine exposure depicted in both case reports and clinical series were used.ĭata Extraction Mortality data from clinical series with more than 30 cases were tabulated. Objective To review the methods and complications of exposing the anterior aspects of the thoracic and lumbosacral spine.ĭata Sources PubMed (journals database of the National Library of Medicine), text books, the University HealthSystem Consortium Clinical Process Improvement Benchmarking Project, a newspaper, and the US government Healthcare Cost and Utilization Project. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.