Traditional approaches to the thoracolumbar spine to treat fractures carry significant morbidity, including pneumothorax (collection of air in the pleural space leading to collapse of the lung), vessel injury, disruption of the nerves of the lumbar plexus, retrograde ejaculation, and development of abdominal or diaphragmatic hernia
In order to minimize this exposure-related morbidity, the extreme-lateral approach is a minimally invasive technique which has been utilized at the UPMC in the treatment of fractures of the thoracic and lumbar spine. We have been successfully using this minimally invasive approach to accomplish decompression of the spinal canal, the nerve roots and also achieve instrumented fusion of unstable (potential to cause neural injury) thoracic and lumbar fractures. Fractures involving the thoracic level T6- 7 and up to the lumbar L4-5 level are accessible to treat utilizing this minimally invasive approach.
The extreme-lateral transpsoas approach utilizes sequential dilation of muscle with continuous neuromonitoring to place an expandable tubular retractor. It provides the additional benefit of minimizing dissection of the great vessels and the sympathetic nerve plexus, thus reducing the risk of vascular injury and retrograde ejaculation. This minimally invasive lateral approach to the thoracic spine offers a very good alternative to an open thoracotomy (opening up the thoracic cavity with a big incision). The lung need not be deflated. Through a small corridor resection of the fractured vertebral body can be accomplished at most levels allowing for decompression, correction of deformity, and instrumented fusion to maintain the structural integrity of the spinal column.
Our experience illustrates the utility of the extreme-lateral approach as a valuable tool in the anterior stabilization and decompression of thoracic and lumbar fractures. The associated incision and tissue morbidity, recovery time, correction of deformity, narcotics usage, and length of stay in the hospital are reduced when utilizing this approach.
Figure A & B above: Drawing demonstrating positioning of the dilator system and the extent of exposure obtained.
Figure C & D above: Drawing demonstrating preparation of vertebral bodies and placement of an expandable cage after resecting the fractured vertebral body.
Figure E: Drawing demonstrating placement of the cage and plate.
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Brain and Spine Injury
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