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Ann Thorac Surg 2008;86:1762-1768. doi:10.1016/j.athoracsur.2008.07.087
© 2008 The Society of Thoracic Surgeons
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Brian L. Pettiford
Matthew J. Schuchert
Michael S. Kent
Peter F. Ferson
James D. Luketich
Rodney J. Landreneau
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Original Articles: General Thoracic

Technical Challenges and Utility of Anterior Exposure for Thoracic Spine Pathology

Brian L. Pettiford, MD*, Matthew J. Schuchert, MD, Geetha Jeyabalan, MD, James R. Landreneau, Arman Kilic, BS, Joshua P. Landreneau, Omar Awais, MD, Michael S. Kent, MD, Peter F. Ferson, MD, James D. Luketich, MD, Andrew B. Peitzman, MD, Rodney J. Landreneau, MD

Heart, Lung, and Esophageal Surgery Institute, and Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Accepted for publication July 23, 2008.

* Address correspondence to Dr Pettiford, Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Shadyside Medical Office Building, Suite 715, 5200 Centre Avenue, Pittsburgh, PA 15232 (Email: pettifordb{at}upmc.edu).

Presented at the Poster Session of the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: Thoracic surgeons are frequently called upon to provide exposure to the anterior cervicothoracic, thoracic, and proximal lumbar spine. We reviewed our surgical experience and the perioperative outcomes of these spinal approaches. Relevant technical and anatomic considerations of each procedure are highlighted.

Methods: A total of 213 patients (116 female, 97 male) undergoing anterior thoracic spinal exposures over an 11-year period at a single institution were analyzed. Primary endpoints include morbidity, mortality, and perioperative outcomes.

Results: Mean age was 53.7 years. Surgical approaches were determined based on the location and length of spinal involvement, and included cervicothoracic (5), thoracotomy (117), and thoracoabdominal (91) techniques. Malignant etiologies were associated with the highest perioperative mortality (6.7%, p = 0.08). Procedures for infection were associated with a significantly higher complication rate (p = 0.041) and length of stay (p = 0.033). Correction of scoliosis required longer operative times (p < 0.001) and resulted in a trend toward higher blood loss (p = 0.16). Thoracoabdominal approaches were associated with increased operative times (386 vs 316 minutes) and length of stay (8 vs 6 days) compared with thoracotomy.

Conclusions: The increased use of anterior approaches to spinal pathology necessitates greater involvement by thoracic surgeons. Familiarity with the anatomic and technical features of the anterior spinal exposure is required by thoracic surgeons to optimize surgical outcomes.






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