The mini-open anterolateral approach for degenerative thoracolumbar disease

Introduction: Anterolateral retroperitoneal, retrodiaphragmatic, and/or retropleural (RPDP) approaches have been used to treat a variety of spinal conditions. The traditional extensive thoracoabdominal approach can be modified to focus on the area of pathology. A less invasive "mini-open" anterolateral approach may be associated with fewer complications and shorter recovery than the thoracoabdominal procedure. There are few reports in the literature describing the technique and results of this less invasive approach to thoracolumbar degenerative pathology. Methods: 417 spinal fusion cases from a single institution were reviewed from 1999 to 2006, and 23 anterolateral mini-open approaches to degenerative spinal pathology were identified. The mini-open approach entailed a 4-8 cm oblique lateral incision with harvesting of a single rib for use in arthrodesis, followed by RPDP access to the lateral spine. A total of 36 levels were fused. These cases were retrospectively reviewed with a minimum of two-year follow-up to determine the feasibility of the approach as well as incidence of complications. In addition, preliminary clinical results were tabulated. Results: One pseudarthrosis and four minor complications were identified. There were no major complications or deaths. Mean length of hospital stay was 4 days. Blood loss was less than 200 cm³ for all cases. Using modified Odom's criteria, 74% of patients had adequate resolution of their symptoms and rated their outcome as satisfactory, good, or excellent. Conclusions: Mini-open anterolateral approaches to the thoracolumbar spine are associated with acceptable outcomes with a low complication rate. Although no direct comparison with the more extensive thoracoabdominal approach has been performed, review of the literature suggests that the mini-open approach reduces complications and length of hospital stay.