Technical Considerations and Morbidity in Anterolateral vs Posterolateral Lumbar Corpectomy

Overview

This systematic review analyzed 64 studies including 702 patients undergoing lumbar corpectomy via anterolateral (AL) or posterolateral (PL) approaches. It compared technical nuances, approach-related morbidity, and outcomes, highlighting differences in indications, instrumentation, and complication rates between the two approaches.

Background

Lumbar corpectomy is a complex spinal procedure indicated for vertebral body fractures, tumors, infections, and degenerative conditions. The lumbar spine's anatomical and biomechanical characteristics differ from the thoracic spine, influencing surgical approach choice. AL approaches provide direct anterior column access but often require additional posterior instrumentation, while PL approaches allow single-session transpedicular instrumentation but pose challenges due to limited visualization and nerve root preservation. Advances such as expandable cages and neuronavigation have improved PL approach feasibility.

Data Highlights

Key Findings

• AL approach was more commonly used for infections and osteoporotic lesions, while PL approach was more frequent in trauma and neoplastic cases.
• Expandable cages were the predominant vertebral body replacement device in both approaches, used in approximately 61-64% of cases.
• Additional posterior instrumentation was required in most AL cases (68.3%), whereas PL corpectomies typically included transpedicular instrumentation in the same surgical session (92%).
• PL approach offers early neural structure visualization and single-session instrumentation but is technically more challenging due to limited anterior visualization and nerve root preservation.
• AL approach provides direct anterior column access but may be less familiar to surgeons and often necessitates staged posterior fixation for biomechanical stability.

Clinical Implications

Surgeons should consider patient pathology and anatomical factors when selecting between AL and PL lumbar corpectomy approaches. The AL approach may be preferred for direct anterior access but requires planning for additional posterior instrumentation. The PL approach, enhanced by modern technologies, allows single-stage surgery with neural visualization but demands technical expertise. Understanding approach-specific morbidity and instrumentation strategies is critical for optimizing outcomes.

Conclusion

Both anterolateral and posterolateral approaches to lumbar corpectomy have distinct technical considerations and morbidity profiles. Selection should be individualized based on pathology, surgeon experience, and available technology to balance surgical exposure, instrumentation needs, and complication risks.

References

1. Systematic Review 2021 -- A Systematic Review of the Technical Considerations and Morbidity Associated with Anterolateral versus Posterolateral Approaches in Lumbar Corpectomy