Application of ventral approaches in surgery of the thoracic and lumbar spine

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Abstract

Twenty-year experience in application of anterior approaches for spine surgery is analyzed. There were 826 patients with acute spinal injuries and their sequlae, spinal tumors, infectious and degenerative spinal lesions as well as spinal deformities. Using the anerior approaches 839 operations were performed. Results of surgical treatment were evaluated by dynamics of neurologic deficit, term and pattern of anterior osseous block development, value of spine correction, rate of postoperative complications, dynamics of functional spine state during rehabilitation period. Data obtained testify the high efficacy of anterior approaches in spine interventions for the treatment of patients with spine injuries and diseases.

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About the authors

A. K. Dudayev

Military Medical Academy

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, St. Petersburg

N. M. Yastrebkov

Military Medical Academy

Email: info@eco-vector.com
Russian Federation, St. Petersburg

V. P. Orlov

Military Medical Academy

Email: info@eco-vector.com
Russian Federation, St. Petersburg

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2. Fig. 1. Patient M., 19 years old. Consequences of severe spinal cord injury: T7-8 consolidated lateral fracture-dislocation, anatomical rupture of the spinal cord, laminectomy defect of the T6-8 vertebral arches, metal implant (mesh type) in the long back muscles, lower spastic paraplegia, dysfunction of the pelvic organs of the central type. Lateral spondylogram (a) and computed tomography (b) before surgical treatment; lateral (c) and anteroposterior (d) spondylograms after resection of the bodies of T7, T8 vertebrae, anterior decompression of the contents of the dural sac, resection of the articular and transverse processes, heads of the ribs at the level of T6-8 vertebrae, revision of the spinal cord, meningoradiculolysis, anterior combined (bone and biositall) fusion, anterior and posterior correction and fixation of the spine with a Z-plate, distractor and contractor.

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3. Fig. 2. Patient A. 47 years old. Solitary myeloma, pathological fracture of the T12 vertebral body with compression of the epiconus of the spinal cord, flaccid lower paraparesis, dysfunction of the pelvic organs. Lateral (a) and anteroposterior (b) spondylograms, magnetic resonance imaging of the lower thoracic and lumbar spine (c) before surgical treatment; lateral (d) and anteroposterior (e) spondylograms after total spondylectomy of the T12 vertebra, anterior T1l—L1 fusion by complete vertebral body replacement, posterior internal transpedicular correction, and fixation of the spine with the Tenor system.

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