Anterior minimally invasive extrapleural retroperitoneal approach to the thoraco-lumbar junction of the spine

• Published in: Orthopaedics & traumatology, surgery & research surgery & research, 2013-02, Vol.99 (1), p.94-98
• Main Authors: Litré, C.F, Duntze, J, Benhima, Y, Eap, C, Malikov, S, Pech-Gourg, G, Blondel, B, Métellus, P, Fuentes, S
• Format: Article
• Language: English
• Subjects: Anatomy; Decompression, Surgical - methods; Humans; Lumbar Vertebrae; Minimally invasive approach; Minimally Invasive Surgical Procedures; Orthopedic Procedures - methods; Orthopedics; Reconstructive Surgical Procedures - methods; Retroperitoneal Space; Spinal cord; Spinal Diseases - diagnosis; Spinal Fractures - surgery; Spinal Neoplasms - surgery; Spine anterior approach; Surgery; Thoracic Vertebrae; Thoraco-lumbar spinal junction
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2012.08.006

Summary Background The anterior approach to the thoraco-lumbar junction of the spine allows therapeutic interventions on post-traumatic, infectious, and neoplastic vertebral lesions from T11 to L2 combining spinal cord decompression, corporectomy, and vertebral body fusion. However, this approach also has a reputation for damaging the intervening anatomic structures (lungs, peritoneum, and diaphragm). The objective of this study was to show that both nervous structure decompression and anterior vertebral reconstruction can be achieved via an anterior minimally invasive extrapleural retroperitoneal (AMIER) approach. Material We describe each of the steps of the AMIER approach to the thoraco-lumbar junction of the spine. Results The AMIER approach ensures excellent exposure that allows full decompression and satisfactory anterior anatomic reconstruction. The main difficulties and complications relate to the lungs, and a painstaking and rigorous technique limits the complications compared to conventional thoraco-phreno-lumbotomy.