457 - Minimally Invasive Direct Lateral Approach to the Thoracolumbar Juncti...

#457 Minimally Invasive Direct Lateral Approach to the Thoracolumbar Junction: Technique and Clinical Case Series

MIS Techniques and Outcomes

Poster Presented by: J.E. O'Toole


D. Straus (1)
I. Takagi (1)
J.E. O'Toole (1)

(1) Rush University Medical Center, Neurological Surgery, Chicago, IL, USA


Background: Multiple surgical exposures of the thoracolumbar junction have been described. The minimally invasive direct lateral approach to the lumbar spine is a recently described technique that captures the advantages of anterolateral approaches, while minimizing soft tissue destruction and perioperative morbidity. Utilizing this approach at the thoracolumbar junction presents unique anatomical challenges.

Methods: We review our technique for performing minimally invasive direct lateral approaches to the thoracolumbar junction (T10-L2), perform an illustrative cadaveric dissection and report our clinical experience with this approach.

Results: We performed minimally invasive direct lateral fusion at the thoracolumbar junction at 12 total levels in 9 patients. Our case series reflects primarily degenerative pathologies. We found this approach to be successful in both single stage and multi-stage procedures for correction of degenerative thoracolumbar deformities. Supplemental internal fixation was used in all cases and solid fusion was achieved at last follow-up in all patients. We experienced 1 episode of posterior hardware failure and 2 post-operative wound infections in posterior wounds only. There were no complications associated with the direct lateral approach.

Discussion: The minimally invasive direct lateral approach offers access to ventral pathology at the thoracolumbar junction and can be performed safely and successfully with minimal soft tissue destruction.