Technical nuances and approach-related morbidity of anterolateral and posterolateral lumbar corpectomy approaches—a systematic review of the literature - Scorecard - MDSpire
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Technical nuances and approach-related morbidity of anterolateral and posterolateral lumbar corpectomy approaches—a systematic review of the literature
Clinical Scorecard: A Systematic Review of the Technical Considerations and Morbidity Associated with Anterolateral versus Posterolateral Approaches in Lumbar Corpectomy
Surgical resection of lumbar vertebral bodies via anterolateral (AL) or posterolateral (PL) approaches with vertebral body replacement and instrumentation
Target Population
Patients undergoing lumbar corpectomy for fractures, tumors, infections, osteoporosis, or deformity
Care Setting
Specialized spinal surgery centers performing complex lumbar corpectomy procedures
Key Highlights
AL approach provides direct visualization of vertebral body but often requires additional posterior instrumentation for stability.
PL approach is technically more challenging due to limited visualization and lumbar nerve root preservation but allows single-session transpedicular instrumentation.
Expandable cages are the most commonly used vertebral body replacement devices in both AL and PL approaches.
Guideline-Based Recommendations
Diagnosis
Indications for lumbar corpectomy include traumatic fractures, neoplastic infiltration, infections, osteoporosis, and degenerative deformities.
Separate outcome data for lumbar corpectomies should be considered due to anatomical and biomechanical differences from thoracic spine.
Management
AL approach is traditionally preferred for anterior column access with additional posterior instrumentation in most cases.
PL approach may be used with recent technical advances (expandable cages, neuronavigation) to mitigate visualization and access challenges.
Instrumentation strategies differ: AL often requires staged posterior fixation, PL typically allows single-session transpedicular instrumentation.
Monitoring & Follow-up
Monitor for approach-related complications including neurological deterioration and reoperation rates.
Evaluate estimated blood loss and length of operation as part of perioperative assessment.
Risks
AL approach risks include challenges related to abdominal organs, vasculature, and need for additional posterior surgery.
PL approach risks include limited visualization, nerve root preservation challenges, and technical difficulty placing vertebral body replacement devices.
Patient & Prescribing Data
702 patients undergoing lumbar corpectomy (513 AL, 189 PL) for trauma, tumors, infection, osteoporosis, or deformity.
Expandable cages used in approximately 61% (AL) and 64% (PL) of cases; additional posterior instrumentation common in AL approach (68.3% of studies).
Clinical Best Practices
Consider AL approach for direct anterior column access but plan for posterior instrumentation to ensure biomechanical stability.
Use PL approach with advanced technologies (expandable cages, neuronavigation) to enable single-stage surgery and early neural structure visualization.
Tailor approach selection based on pathology, anatomical considerations, and surgeon expertise.
Careful preoperative planning to mitigate approach-related morbidity and optimize neurological outcomes.
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