Anterior Versus Posterior Approach for Thoracic Corpectomy: An Analysis of Risk Factors, Outcomes, and Complications.

BACKGROUND

Thoracic corpectomies are performed for various reasons, including spinal deformity, trauma, neoplasms, and infection. Regardless of indication, both anterior and posterior approaches are surgical options, selected based on pathology, anatomy, patient characteristics, and surgical experience. Risk profiles and outcomes for these procedures are poorly characterized, however, and the choice between the 2 approaches remains inconclusive.

OBJECTIVE

To compare risk factors and complications for adult patients undergoing anterior and posterior thoracic corpectomies.

METHODS

A review of the American College of Surgeons National Quality Improvement Program database was performed, with 30-day patient outcomes after anterior or posterior thoracic corpectomy queried from 2005 to 2016. Preoperative risk factors and postoperative outcomes (e.g., deaths, reoperations, readmissions) were identified and compared.

RESULTS

In total, 1327 corpectomies were studied, 861 (64.9%) by an anterior approach and 465 (35.1%) by a posterior approach. Patients undergoing a posterior approach were generally male, older, and had a greater American Association of Anesthesiologists class, whereas those subject to anterior approaches had a greater average body mass index. After we controlled for these baseline characteristics, no significant difference in postoperative events was observed, with 9.3% of anterior approach patients and 7.1% of posterior approach patients returning to the operating room within 30 days.

CONCLUSIONS

No significant difference in rates of reoperation, readmission, death, average length of stay, or medical complications exists between anterior and posterior thoracic corpectomy approaches. Both have relatively low-risk profiles and, in situations in which either strategy is reasonable, each can be selected at the surgeon's discretion with comparable risk.