The study included 7 patients with kyphotic deformity. They consist of 4 males and 3 females with the mean age 26.2 years old (range 14-29 years old). 6 patients with spondylitis tuberculosis, and 1 patient with metastasis bone disease. The lesion location of 6 cases at the thoracal vertebra, and 1 case at the thoracolumbal vertebra. The mean of local/regional kyphotic pre operation was 45.20 (range 42-530). From neurological status, 4 patients with Frankel B, 2 patients with Frankel C, and 1 patient with Frankel D. The mean estimated blood loss was 1280cc (range 1100cc-1700cc). The mean length of surgery was 3.9 h (range 3.7-4.5 h). The mean length of stay in the hospital was 4.5 days (range 4-7 days). None of the patient had neurological deficit, and all of them have shown kyphotic improvement with mean local/regional kyphotic post operation was 30.50 (range 28 -35 ).
The posterior approach to the anterior spine has long been an attractive option for spinal surgeons (Fig. 1). The modified lateral extracavitary approach was developed in part by Norman Capener and then modified by Sanford Larson and others. Many of its advantages arise from the ability to avoid morbidity associated with anterior or lateral incisions. This is particularly important in the oncologic and infecton setting because many of the patients have already had interventions such as surgery, chemotherapy, or radiation that can compromise pulmonary function or increase the difficulty of gaining exposure. Though versatile, the lateral extracavitary approach is technically challenging, associated with high blood loss and wound-healing problems, and anterior cage placement is often smaller than that in traditional anterior exposure.
In our series, we successfully used the lateral extracavitary approach to perform circumferential anterior column reconstruction for kyphotic deformity, with an anterior cage and supplemental instrumented posterior at least two - three levels above and below resection (Fig. 2). The average blood loss was 1280 ml. This is better compare to the 1580 ml mean EBL reported by Xu et al. who used transpedicular or lateral extracavitary approaches. It is also in the range of values reported by Lu et al. (1320 ml), and Wang et al. (1250 ml). Our technique was different than the classical lateral extracavitary approach performed through a paramedian incision. The incision and subsequent maneuvers that we employed are similar to those described by Snell et al. It was critical that we used a midline incision: this allowed us to work without significant impedance from the scapula. Furthermore, the midline approach facilitated a circumferential access to resection.