The Use of Transthoracic and Ventro-lateral Access in the Surgical Treatment of Extradural Spinal Tumors in the Thoracic and Lumbar Areas

Abstract

Surgical treatment of ventral extradural space-occupying lesions of the spine is commonly performed by means of decompressive laminectomy. While relief of the spinal cord or the cauda equina usually results in temporary reduction of pain and of neurological disturbances, the long-term results of such therapy are unsatisfactory. Thus in the current literature on surgery almost all authors uniformly report very poor results (e.g., 1, 7, 8 ). In 1965 BRICE and McKISSOCK (1) traced the later condition of 145 patients who had initially suffered from ventral thoracic space-occupying lesions, including thoracic herniation of intervertebral disks, which had been treated by means of laminectomy. In merely 30% of the cases was the result termed satisfactory. No patient with an exclusively ventral lesion showed an improvement. The poor results of decompressive laminectomy on the one hand and the good results that have been obtained by means of an anterolateral transthoracic approach to the thoracic spinal column on the other (2, 3, 6 7) make it attractive also to remove ventral thoracic and lumbar spinal lesions ventrally, as has long been the practice in the cervical area. The steps to achieve ventral access to the thoracic and lumbar sections of the spinal column have been sufficiently standardized in the course of recent years (4, 9).