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Open AccessArticle

Fewer Cardiopulmonary Complications and Shorter Length of Stay in Anterolateral Thoracolumbar Spine Exposures Using a Small-Incision Specialized Retractor System

1
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
2
Division of Vascular and Endovascular Surgery, Cooper University HealthCare, Camden, NJ 08103, USA
3
Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX 77030, USA
4
Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
5
Memorial Hermann Hospital—Texas Medical Center, Houston, TX 77030, USA
6
HCA Houston Healthcare, Gulf Coast Division, Houston, TX 77004, USA
7
Department of Clinical Sciences, University of Houston College of Medicine, Houston, TX 77204, USA
*
Author to whom correspondence should be addressed.
Presented at the Society for Vascular Surgery Annual Meeting 2018-Fewer Complications with Smaller Incisions in Anterolateral Spine Exposures, Boston, MA, USA, 21 June 2018.
J. Clin. Med. 2020, 9(10), 3119; https://doi.org/10.3390/jcm9103119
Received: 1 August 2020 / Revised: 21 September 2020 / Accepted: 22 September 2020 / Published: 27 September 2020
(This article belongs to the Special Issue New Updates on Cardiovascular and Thoracic Surgery)
Objectives: One of the challenges of spine surgery is the need for adequate exposure of the anterolateral spinal column. Improved retractor systems with integrated lighting minimize the need for large thoracotomy, flank, or abdominal incisions. In 2013, we began using the NuVasive MaXcess® system via a minimal-access lateral incision for thoracic and thoracolumbar spine exposures. These small-access approaches may not offer adequate exposure when bleeding and other complications arise. We sought to determine the feasibility and outcomes of a minimal-access retractor during anterolateral spine exposures. Methods: An institutional-review-board-approved retrospective chart review was performed of all patients who underwent anterolateral thoracic and lumbosacral spine exposure at an academic hospital between December 1999 and April 2017. Cervical and posterior spine exposures were not included. Information regarding patient demographics, comorbid conditions, operative techniques, exposure, estimated blood loss, length of stay, and intraoperative and postoperative complications was collected. Data for standard exposure vs. minimally invasive exposures were compared. Results: Between December 1999 and April 2017, 223 anterolateral spinal exposures were performed at our institution. Of those, 122 (54.7%) patients had true lateral exposures, with 22 (18%) using the minimally invasive retractor. The mean age of our patient population was 57 years (19–89), with 65 (53%) men and a mean body mass index of 29.0 (17.4–58.6). In the standard exposure group, complications occurred in 22 (22%) patients, whereas only two (9%) complications occurred in the minimal-access group. There were no significant differences in overall intraoperative and postoperative complications, except for cardiopulmonary complications, which were reduced in the minimally invasive group (p < 0.019). Patients with minimally invasive exposure had a significantly shorter length of stay than those with standard exposure (7 vs. 13 days, p = 0.001). Conclusions: Minimal-access techniques using advanced retractor systems are both feasible and safe compared to standard techniques allowing for similar lateral spine exposure, but with smaller incisions, fewer cardiopulmonary complications, and shorter lengths of stay. View Full-Text
Keywords: anterolateral spine exposure; XLIF; minimally invasive spine retractor anterolateral spine exposure; XLIF; minimally invasive spine retractor
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Khan-Makoid, S.; Tjaden, B.L., Jr.; Leake, S.S.; McFall, R.G.; Miller, C.C., III; Sandhu, H.K.; Schmitt, K.; Charlton-Ouw, K.M. Fewer Cardiopulmonary Complications and Shorter Length of Stay in Anterolateral Thoracolumbar Spine Exposures Using a Small-Incision Specialized Retractor System. J. Clin. Med. 2020, 9, 3119.

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