Lateral extracavitary vs costotransversectomy approaches to the thoracic spine: Reflections on lessons learned

Daniel Lubelski, Kalil G. Abdullah, Thomas E. Mroz, John H. Shin, Matthew D. Alvin, Edward C. Benzel, Michael P. Steinmetz

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND: The lateral extracavitary approach (LECA) and costotransversectomy (CTE) are 2 dorsolateral approaches that avoid entrance into the pleural cavity and facilitate ventral decompression. The indications and outcomes of each of these approaches have not been fully defined in the literature. OBJECTIVE: To assess the techniques, indications, and complications associated with the LECA and CTE approaches to the thoracic spine. METHODS: A retrospective analysis was performed on all patients who underwent LECA and CTE between 2000 and 2009 at our institution. RESULTS: A total of 54 patient charts were reviewed (19 LECA, 35 CTE). Indications for operation included disk herniation, trauma, tumor, osteomyelitis, and scoliosis/kyphosis. Osteomyelitis was treated significantly more often with LECA (47%) than with CTE (9%; P=.002). Mean blood loss was 2134 mL and 1556 mL (P=.3) in LECA and CTE, respectively, and hospital stay was 17.2 days for LECA and 9.8 days for CTE (P=.07). Thirteen LECA patients (68%) and 19 CTE patients (54%; P=1.0) had preoperative or postoperative complications. CONCLUSION: LECA was used more often to treat complex pathologies such as osteomyelitis and trended toward significance for more frequent use in extensive procedures involving 1- or 2-level corpectomies. As can be expected, CTE was associated with slightly less blood loss and a shorter hospital stay compared with the more extensive LECA operation. Adverse outcomes occurred with similar frequency for CTE and LECA.

Original languageEnglish (US)
Pages (from-to)1096-1102
Number of pages7
JournalNeurosurgery
Volume71
Issue number6
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

Fingerprint

Spine
Osteomyelitis
Thorax
Length of Stay
Pleural Cavity
Kyphosis
Scoliosis
Decompression
Pathology
Wounds and Injuries
Neoplasms

Keywords

  • Complications
  • Costotransversectomy
  • Indications
  • Lateral extracavitary
  • Thoracic spine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Lateral extracavitary vs costotransversectomy approaches to the thoracic spine : Reflections on lessons learned. / Lubelski, Daniel; Abdullah, Kalil G.; Mroz, Thomas E.; Shin, John H.; Alvin, Matthew D.; Benzel, Edward C.; Steinmetz, Michael P.

In: Neurosurgery, Vol. 71, No. 6, 01.12.2012, p. 1096-1102.

Research output: Contribution to journalArticle

Lubelski, Daniel ; Abdullah, Kalil G. ; Mroz, Thomas E. ; Shin, John H. ; Alvin, Matthew D. ; Benzel, Edward C. ; Steinmetz, Michael P. / Lateral extracavitary vs costotransversectomy approaches to the thoracic spine : Reflections on lessons learned. In: Neurosurgery. 2012 ; Vol. 71, No. 6. pp. 1096-1102.
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abstract = "BACKGROUND: The lateral extracavitary approach (LECA) and costotransversectomy (CTE) are 2 dorsolateral approaches that avoid entrance into the pleural cavity and facilitate ventral decompression. The indications and outcomes of each of these approaches have not been fully defined in the literature. OBJECTIVE: To assess the techniques, indications, and complications associated with the LECA and CTE approaches to the thoracic spine. METHODS: A retrospective analysis was performed on all patients who underwent LECA and CTE between 2000 and 2009 at our institution. RESULTS: A total of 54 patient charts were reviewed (19 LECA, 35 CTE). Indications for operation included disk herniation, trauma, tumor, osteomyelitis, and scoliosis/kyphosis. Osteomyelitis was treated significantly more often with LECA (47{\%}) than with CTE (9{\%}; P=.002). Mean blood loss was 2134 mL and 1556 mL (P=.3) in LECA and CTE, respectively, and hospital stay was 17.2 days for LECA and 9.8 days for CTE (P=.07). Thirteen LECA patients (68{\%}) and 19 CTE patients (54{\%}; P=1.0) had preoperative or postoperative complications. CONCLUSION: LECA was used more often to treat complex pathologies such as osteomyelitis and trended toward significance for more frequent use in extensive procedures involving 1- or 2-level corpectomies. As can be expected, CTE was associated with slightly less blood loss and a shorter hospital stay compared with the more extensive LECA operation. Adverse outcomes occurred with similar frequency for CTE and LECA.",
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AU - Lubelski, Daniel

AU - Abdullah, Kalil G.

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AU - Shin, John H.

AU - Alvin, Matthew D.

AU - Benzel, Edward C.

AU - Steinmetz, Michael P.

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N2 - BACKGROUND: The lateral extracavitary approach (LECA) and costotransversectomy (CTE) are 2 dorsolateral approaches that avoid entrance into the pleural cavity and facilitate ventral decompression. The indications and outcomes of each of these approaches have not been fully defined in the literature. OBJECTIVE: To assess the techniques, indications, and complications associated with the LECA and CTE approaches to the thoracic spine. METHODS: A retrospective analysis was performed on all patients who underwent LECA and CTE between 2000 and 2009 at our institution. RESULTS: A total of 54 patient charts were reviewed (19 LECA, 35 CTE). Indications for operation included disk herniation, trauma, tumor, osteomyelitis, and scoliosis/kyphosis. Osteomyelitis was treated significantly more often with LECA (47%) than with CTE (9%; P=.002). Mean blood loss was 2134 mL and 1556 mL (P=.3) in LECA and CTE, respectively, and hospital stay was 17.2 days for LECA and 9.8 days for CTE (P=.07). Thirteen LECA patients (68%) and 19 CTE patients (54%; P=1.0) had preoperative or postoperative complications. CONCLUSION: LECA was used more often to treat complex pathologies such as osteomyelitis and trended toward significance for more frequent use in extensive procedures involving 1- or 2-level corpectomies. As can be expected, CTE was associated with slightly less blood loss and a shorter hospital stay compared with the more extensive LECA operation. Adverse outcomes occurred with similar frequency for CTE and LECA.

AB - BACKGROUND: The lateral extracavitary approach (LECA) and costotransversectomy (CTE) are 2 dorsolateral approaches that avoid entrance into the pleural cavity and facilitate ventral decompression. The indications and outcomes of each of these approaches have not been fully defined in the literature. OBJECTIVE: To assess the techniques, indications, and complications associated with the LECA and CTE approaches to the thoracic spine. METHODS: A retrospective analysis was performed on all patients who underwent LECA and CTE between 2000 and 2009 at our institution. RESULTS: A total of 54 patient charts were reviewed (19 LECA, 35 CTE). Indications for operation included disk herniation, trauma, tumor, osteomyelitis, and scoliosis/kyphosis. Osteomyelitis was treated significantly more often with LECA (47%) than with CTE (9%; P=.002). Mean blood loss was 2134 mL and 1556 mL (P=.3) in LECA and CTE, respectively, and hospital stay was 17.2 days for LECA and 9.8 days for CTE (P=.07). Thirteen LECA patients (68%) and 19 CTE patients (54%; P=1.0) had preoperative or postoperative complications. CONCLUSION: LECA was used more often to treat complex pathologies such as osteomyelitis and trended toward significance for more frequent use in extensive procedures involving 1- or 2-level corpectomies. As can be expected, CTE was associated with slightly less blood loss and a shorter hospital stay compared with the more extensive LECA operation. Adverse outcomes occurred with similar frequency for CTE and LECA.

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KW - Costotransversectomy

KW - Indications

KW - Lateral extracavitary

KW - Thoracic spine

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