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Basem Awad

Basem Awad

Mansoura University Hospital, Egypt

Title: Lateral extracavitary approach to spinal tumors

Biography

Biography: Basem Awad

Abstract

The surgical management of pathology involving the ventral aspect of the thoracic and upper lumbar spine is typically challenging. Thoracotomy provides direct ventral exposure of the spine and spinalcord. However the approach related morbidities could be markedly significant while a separate dorsal approach may be required for instrumentation. The Lateral Extracavitary Approach (LECA) is a dorsolateral approach that provides lateral and ventral access to thoracic and upper lumbar spine without entrance into the pleural cavity. By remaining extra pleural, the LECA avoids the complications noticed previously with thoracotomy. Neural decompression, tumor removal and fixation can all be accomplished via LECA, which makes it an invaluable tool in spinal surgery. This technical advantage has led to excellent neurological outcomes with nearly 75% of patients described in the literature revealing neurological improvement. In the present study, we reviewed 15 patients with spinal tumors treated with anterior and posterior resection and reconstruction from a single posterior approach. Pre- and post-operative neurological condition means blood loss, length of hospital stay after surgery and complications related directly to surgery were analyzed. Pre- and post-operative Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) scans were evaluated. Our results showed neurological improvement in 69.2%, 29.2% experienced no change and 1.5% reported worse condition. Mean blood loss was 2,134 mL and hospital stay was 7.2 days. Total complication rate were 15.5%. In conclusion the adequate neural decompression combined with anterior and posterior column reconstruction is feasible through lateral extracavitary approach using a single posterior skin incision. Minimally Invasive (MIS) approaches are now being applied in all areas of the spine surgeries including LECA. MIS LECA approach is purported to have decreased operative time, reduced blood loss, less tissue dissection, less perioperative pain and earlier mobility.