Single-surgeon Extensile Approach and Fixation of Thoraco-lumbar Pathology: A Review of our Experience.

Abstract

Background: Extensile approaches to the thoracic and lumbar spine are required for tumours, fractures, malignancies, deformity corrections and degenerative diseases. The body cavities (thorax and abdomen) require different approaches depending on the primary pathology and the desired exposure plus fixation method. There is usually two teams involved: the ‘exposure surgeon’ and the ‘operating surgeon’. Such a team is usually not feasible in developing countries. The purpose of this paper is to find out whether it is safe for a single surgeon to do both the exposure and the operation. Methods: Nineteen patients operated on by a single surgeon over a three-year period were reviewed. This is a retrospective study. The information was obtained from clinical records. Results: There were 10 females and 9 males, all below the age of 60 years. Four cases were due to infection, 14 due to trauma and 1 due to metastasis. The approach was dictated to by the pathology. The approaches were thoracotomy in 5, trans-thoracic trans-diaphragmatic retroperitoneal in 5 and 12^th rib sub costal retroperitoneal in 9. There were 4 intra-operative and 1 post-operative significant complications. All were managed successfully. Conclusion: An experienced spinal surgeon can safely do both the approach and operative intervention. The complications can be safely managed. There is no increase in the complication rate.