Neurosurgery: Anterior Spinal Approach

Anterior Spinal Approach

General Indications

  • Anterior Lumbar Interbody Fusion (ALIF)
  • Trauma
  • Infection
  • Neoplasia
  • Kyphosis or Scoliosis

Cervical Spine

  • Many Different Complex Approaches (Transoral, Retropharyngeal, Maxillotomy, Anterolateral, etc.)

Thoracic Spine

  • Left Thoracotomy Generally Preferred
  • If High, Some Prefer Right Thoracotomy to Avoid Great Vessels
  • May Require Rib Resection
  • Video-Assisted Thoracic Surgery (VATS) is Evolving

Lumbar Spine

  • L1-L5: Generally an Anterior Retroperitoneal Approach from Left Lateral Side Not Requiring Peritoneal Violation
  • L5-S1: Generally an Anterior Transperitoneal Approach with Laparotomy
    • Requires Mobilization of the Left Common Iliac Vessels
    • Most Commonly Injured Vessel: Left Common Iliac Vein (2-4%)

Complications

  • Overall: 5-15%
  • Major Vascular Injury: 1-3%
  • Minor Vascular Injury: 24%