Simultaneous anterior-posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization

D. R. Fourney, D. Abi-Said, L. D. Rhines, G. L. Walsh, F. F. Lang, I. E. McCutcheon, Z. L. Gokaslan

Research output: Contribution to journalArticle

Abstract

Object. Thoracic or lumbar spine malignant tumors involving both the anterior and posterior columns represent a complex surgical problem. The authors review the results of treating patients with these lesions in whom surgery was performed via a simultaneous anterior-posterior approach. Methods. The hospital records of 26 patients who underwent surgery via simultaneous combined approach for thoracic and lumbar spinal tumors at our institution from July 1994 to March 2000 were reviewed. Surgery was performed with the patients in the lateral decubitus position for the procedure. The technical details are reported. The mean survival determined by Kaplan-Meier analysis was 43.4 months for the 15 patients with primary malignant tumors and 22.5 months for the 11 patients with metastatic spinal disease. At 1 month after surgery, 23 (96%) of 24 patients who complained of pain preoperatively reported improvements (p <0.001, Wilcoxon signed-rank test), and eight (62%) of 13 patients with preoperative neurological deficits were functionally improved (p = 0.01). There were nine major complications, five minor complications, and no deaths within 30 days of surgery. Two patients (8%) later underwent surgery for recurrent tumor. Conclusions. The simultaneous anterior-posterior approach is a safe and feasible alternative for the exposure tumors of the thoracic and lumbar spine that involve both the anterior and posterior columns. Advantages of the approach include direct visualization of adjacent neurovascular structures, the ability to achieve complete resection of lesions involving all three columns simultaneously (optimizing hemostasis), and the ability to perform excellent dorsal and ventral stabilization in one operative session.

Original languageEnglish (US)
Pages (from-to)232-244
Number of pages13
JournalJournal of Neurosurgery
Volume94
Issue number2 SUPPL.
StatePublished - 2001
Externally publishedYes

Fingerprint

Spine
Thorax
Neoplasms
Aptitude
Spinal Diseases
Hospital Records
Kaplan-Meier Estimate
Nonparametric Statistics
Hemostasis
Ambulatory Surgical Procedures
Pain
Survival

Keywords

  • Anterior-posterior approach
  • Reconstructive surgery
  • Spinal stabilization
  • Spine
  • Tumor

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Fourney, D. R., Abi-Said, D., Rhines, L. D., Walsh, G. L., Lang, F. F., McCutcheon, I. E., & Gokaslan, Z. L. (2001). Simultaneous anterior-posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization. Journal of Neurosurgery, 94(2 SUPPL.), 232-244.

Simultaneous anterior-posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization. / Fourney, D. R.; Abi-Said, D.; Rhines, L. D.; Walsh, G. L.; Lang, F. F.; McCutcheon, I. E.; Gokaslan, Z. L.

In: Journal of Neurosurgery, Vol. 94, No. 2 SUPPL., 2001, p. 232-244.

Research output: Contribution to journalArticle

Fourney, DR, Abi-Said, D, Rhines, LD, Walsh, GL, Lang, FF, McCutcheon, IE & Gokaslan, ZL 2001, 'Simultaneous anterior-posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization', Journal of Neurosurgery, vol. 94, no. 2 SUPPL., pp. 232-244.
Fourney, D. R. ; Abi-Said, D. ; Rhines, L. D. ; Walsh, G. L. ; Lang, F. F. ; McCutcheon, I. E. ; Gokaslan, Z. L. / Simultaneous anterior-posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization. In: Journal of Neurosurgery. 2001 ; Vol. 94, No. 2 SUPPL. pp. 232-244.
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abstract = "Object. Thoracic or lumbar spine malignant tumors involving both the anterior and posterior columns represent a complex surgical problem. The authors review the results of treating patients with these lesions in whom surgery was performed via a simultaneous anterior-posterior approach. Methods. The hospital records of 26 patients who underwent surgery via simultaneous combined approach for thoracic and lumbar spinal tumors at our institution from July 1994 to March 2000 were reviewed. Surgery was performed with the patients in the lateral decubitus position for the procedure. The technical details are reported. The mean survival determined by Kaplan-Meier analysis was 43.4 months for the 15 patients with primary malignant tumors and 22.5 months for the 11 patients with metastatic spinal disease. At 1 month after surgery, 23 (96{\%}) of 24 patients who complained of pain preoperatively reported improvements (p <0.001, Wilcoxon signed-rank test), and eight (62{\%}) of 13 patients with preoperative neurological deficits were functionally improved (p = 0.01). There were nine major complications, five minor complications, and no deaths within 30 days of surgery. Two patients (8{\%}) later underwent surgery for recurrent tumor. Conclusions. The simultaneous anterior-posterior approach is a safe and feasible alternative for the exposure tumors of the thoracic and lumbar spine that involve both the anterior and posterior columns. Advantages of the approach include direct visualization of adjacent neurovascular structures, the ability to achieve complete resection of lesions involving all three columns simultaneously (optimizing hemostasis), and the ability to perform excellent dorsal and ventral stabilization in one operative session.",
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AU - Rhines, L. D.

AU - Walsh, G. L.

AU - Lang, F. F.

AU - McCutcheon, I. E.

AU - Gokaslan, Z. L.

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