Via de acesso para exposição ampla da coluna toracolombar anterior (T10 -L5)

Caffaro, Roberto Augusto; Castelli Júnior, Valter; Karakhanian, Walter Khegan; Silveira, Denise Rabelo da; Guedes, Jorge Henrique; Fonseca, Cândido Ferreira da

doi:10.1590/S0100-69911998000400008

Resumos

Os autores descrevem técnica de via de acesso para exposição ampla da coluna toracolombar anterior (T10 -L5) a que foi submetida uma série de cem pacientes com indicação cirúrgica para correção de diversas doenças da coluna. A partir das estruturas envolvidas, são analisados e comentados os tempos operatórios pertinentes bem como as complicações transoperatórias e pós-operatórias decorrentes da técnica. Sugere-se que a técnica de acesso proposta seja utilizada quando adequada à doença a cuja correção se destina, independente da área de comprometimento clinicamente objetivada.

Coluna toracolombar anterior; Via de acesso; Técnica cirúrgica: Descrição; Cirurgia vascular

The authors describe a technique for extensive anterior approach to the thoracolumbar spine (T10 -L5), to which 100 patients with surgical indication for correcting orthopedic anomalies were submitted. The anatomical structures involved in surgical procedures are analyzed and discussed. Results have shown that this extensive anterior approach to the thoracolumbar spine a) allows the aimed approach in 100% for the cases, making easier the arthopedic management necessary to the correction of the spine deformity to be treated; b) makes possible to avoid transoperative complications from the knowledge of anatomical structures exposed in the surgical field, except for the sympathetic trunk, in which lesion can occur in 70% of cases; and c) presents a low rate (2%) of post operative complications. It is suggested that this technique for extensive anterior approach to the thoracolumbar spine should be used, independently of the extension of the clinically diagnosed affected area.

Anterior thoracolumbar spine; Surgical approach; Operative technique; Description vascular surgery

ARTIGOS ORIGINAIS

Via de acesso para exposição ampla da coluna toracolombar anterior (T₁₀-L₅)

Extensive anterior approach to the thoracolumbar spine (T₁₀-L₅)

Roberto Augusto Caffaro, TCBC-SP^I; Valter Castelli Júnior, TCBC-SP^II; Walter Khegan Karakhanian, TCBC-SP^II; Denise Rabelo da Silveira, ACBC-SP^III; Jorge Henrique Guedes^III; Cândido Ferreira da Fonseca^III

^ICirurgião Vascular, Professor Adjunto e Chefe da Disciplina de Cirurgia Vascular do Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo

^IICirurgião Vascular, Professor Assistente da Disciplina de Cirurgia Vascular do Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo

^IIICirurgião Vascular, Pós-Graduando da Disciplina de Cirurgia Vascular do Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo

^{Endereço para correspondência} Endereço para correspondência: Dr. Roberto Augusto Caffaro Av. Paes de Barros, 896 03114-000 - São Paulo - SP

RESUMO

Os autores descrevem técnica de via de acesso para exposição ampla da coluna toracolombar anterior (T₁₀-L₅) a que foi submetida uma série de cem pacientes com indicação cirúrgica para correção de diversas doenças da coluna. A partir das estruturas envolvidas, são analisados e comentados os tempos operatórios pertinentes bem como as complicações transoperatórias e pós-operatórias decorrentes da técnica. Sugere-se que a técnica de acesso proposta seja utilizada quando adequada à doença a cuja correção se destina, independente da área de comprometimento clinicamente objetivada.

Unitermos: Coluna toracolombar anterior: Via de acesso; Técnica cirúrgica: Descrição; Cirurgia vascular.

ABSTRACT

The authors describe a technique for extensive anterior approach to the thoracolumbar spine (T₁₀-L₅), to which 100 patients with surgical indication for correcting orthopedic anomalies were submitted. The anatomical structures involved in surgical procedures are analyzed and discussed. Results have shown that this extensive anterior approach to the thoracolumbar spine a) allows the aimed approach in 100% for the cases, making easier the arthopedic management necessary to the correction of the spine deformity to be treated; b) makes possible to avoid transoperative complications from the knowledge of anatomical structures exposed in the surgical field, except for the sympathetic trunk, in which lesion can occur in 70% of cases; and c) presents a low rate (2%) of post operative complications. It is suggested that this technique for extensive anterior approach to the thoracolumbar spine should be used, independently of the extension of the clinically diagnosed affected area.

Key words: Anterior thoracolumbar spine; Surgical approach; Operative technique; Description vascular surgery.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 10/10/97

Aceito para publicação em 16/398

Trabalho realizado na Disciplina de Cirurgia Vascular do Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo.

1. Hibbs RA. A report of fifty-nine cases of scoliosis treated by fusion operation. J Bone Joint Surg 1924;6:3-37.
2. Lowman CR. Continuous traction in the treatment of spinal conditions, notably scoliosis. J Bone Joint Surg 1928;10: 114-23.
3.Cotrel Y, O' Amore M. Spinal traction in scoliosis. In: Symposium on scoliosis, 2 Edinburg, Livingstone, 1968. Proceeding, p.37-43.
4. Perry JL, Nickel VL. Total cervical spine-fusion for neck paralysis. J Bone Joint Surg 1959;4IA:37-59.
5. Harrington PR. Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg 1962; 44A:591-96.
6. Dwyer AF. A fatal complication of paravertebral infection and traumatic aneurysm following Dwyer instrumentation. J Bone Joint Surg 1979;61:239.
7. Luque ER. The anatomic basis and development of segmental spinal instrumentation. Spine 1982;7:256-59.
8. Muller W. Transperitoneale Freilegung der Wirbels, ule hei Tuberkul. ser Spondylitis. Dtsch Z Chir 1906;85:128.
9. Royle ND. The operative removal of an accessory vertebrae. Med J Aust 1928;1:467.
10. Ito H, Tsuchiya J, Asami G. A new radical operation for Pott disease. J Bone Ft Surg 1934;16:499.
11. Gjessing MH. Osteoplastic anterior fusion of the lower lumbar spine in spondylolisthesis, localized spondylosis. Acta Ortopaed 1951; 20:200.
12. Hodgson AR, Stock FE. Anterior spinal fusion. A preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. Br J Surg 1956;43:266-75.
13. Hodgson AR, Sotck FE, Fang HSY, et al. Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott's disease of the spine. Br J Surg 1960;47:172-79.
14. Dwyer AF, Newton NC, Sherwood AA. An anterior approach to scoliosis. Clin Orthop Rel Res 1969;62:192-202.
15. Riseborough EJ. The anterior approach to the spine for the correction of deformities of the axial skeleton. Clin Orthop Rel Res 1973; 91: 207-14.
16. Zielke K, Stunkat R, Beaujean J. Anterior spinal instrumentation. Orthop Trans 1978;2:270.
17. Bohlman HH, Eismont FJ. Surgical techniques of anterior decompression and fusion spinal cord injuries. Clin Orthop Rel Res 1980; 154:57-67.
18. Johnson RM, McGuirre EJ. Urogenital complications of anterior approaches to the lumbar spine. Clin Orthop Rel Res 1981;154: 114-18.
19. Kostuik JP, Matsusaki H. Anterior stabilization, instrumentation, and decompression for post-traumatic kyphosis. Spine 1989; 14: 379-86.
20. Kostuik JP, Carl A, Ferron S. Anterior zielke instrumentation for spinal deformity in adults. J Bone Joint Surg 1989;71A:898-912.
21. Hodge WA, DeWald RL. Splenic injury complicating the anterior thoracoabdominal surgical approach for scoliosis. J Bone Joint Surg 1983;665A:396-97.
22. Slawski OP, Bridwell KH, Manley CB. Acute renal obstruction after combined anterior and posterior athrodeses on the convex side of the spine. J Bone Joint Surg 1990;72A:l.259-61.
23. Bradford OS, Ahmed KB, Moe JH, et al. The surgical management of patients with Scheuermann's disease. J Bone Joint Surg 1980; 62: 705-12.
24. Flynn JC, Hoque MA. Anterior fusion of the lumbar spine. J Bone Joint Surg 1979;61A:l.143-50.
25. Smith TK, Stallone RJ, Yee JM. The thoracic surgeon and anterior spinal surgery. J Thorac Cardiovasc Surg 1979;77:925-28.
26. Burrington JD, Brown C, Wayne ER, Odom J. Anterior approach to the thoracolumbar spine. Arch Surg 1976;111:456-63.
27. Slye DA. Orthopedic complications. Nurs Clin North Am 1991; 26: 1.113-33.

Endereço para correspondência:

Dr. Roberto Augusto Caffaro

Av. Paes de Barros, 896

03114-000 - São Paulo - SP

Datas de Publicação

Publicação nesta coleção
26 Jul 2010
Data do Fascículo
Ago 1998

Histórico

Aceito
16 Mar 1998
Recebido
10 Out 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Hibbs RA. A report of fifty-nine cases of scoliosis treated by fusion operation. J Bone Joint Surg 1924;6:3-37.

[2] 2. Lowman CR. Continuous traction in the treatment of spinal conditions, notably scoliosis. J Bone Joint Surg 1928;10: 114-23.

[3] 3.Cotrel Y, O' Amore M. Spinal traction in scoliosis. In: Symposium on scoliosis, 2 Edinburg, Livingstone, 1968. Proceeding, p.37-43.

[4] 4. Perry JL, Nickel VL. Total cervical spine-fusion for neck paralysis. J Bone Joint Surg 1959;4IA:37-59.

[5] 5. Harrington PR. Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg 1962; 44A:591-96.

[6] 6. Dwyer AF. A fatal complication of paravertebral infection and traumatic aneurysm following Dwyer instrumentation. J Bone Joint Surg 1979;61:239.

[7] 7. Luque ER. The anatomic basis and development of segmental spinal instrumentation. Spine 1982;7:256-59.

[8] 8. Muller W. Transperitoneale Freilegung der Wirbels, ule hei Tuberkul. ser Spondylitis. Dtsch Z Chir 1906;85:128.

[9] 9. Royle ND. The operative removal of an accessory vertebrae. Med J Aust 1928;1:467.

[10] 10. Ito H, Tsuchiya J, Asami G. A new radical operation for Pott disease. J Bone Ft Surg 1934;16:499.

[11] 11. Gjessing MH. Osteoplastic anterior fusion of the lower lumbar spine in spondylolisthesis, localized spondylosis. Acta Ortopaed 1951; 20:200.

[12] 12. Hodgson AR, Stock FE. Anterior spinal fusion. A preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. Br J Surg 1956;43:266-75.

[13] 13. Hodgson AR, Sotck FE, Fang HSY, et al. Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott's disease of the spine. Br J Surg 1960;47:172-79.

[14] 14. Dwyer AF, Newton NC, Sherwood AA. An anterior approach to scoliosis. Clin Orthop Rel Res 1969;62:192-202.

[15] 15. Riseborough EJ. The anterior approach to the spine for the correction of deformities of the axial skeleton. Clin Orthop Rel Res 1973; 91: 207-14.

[16] 16. Zielke K, Stunkat R, Beaujean J. Anterior spinal instrumentation. Orthop Trans 1978;2:270.

[17] 17. Bohlman HH, Eismont FJ. Surgical techniques of anterior decompression and fusion spinal cord injuries. Clin Orthop Rel Res 1980; 154:57-67.

[18] 18. Johnson RM, McGuirre EJ. Urogenital complications of anterior approaches to the lumbar spine. Clin Orthop Rel Res 1981;154: 114-18.

[19] 19. Kostuik JP, Matsusaki H. Anterior stabilization, instrumentation, and decompression for post-traumatic kyphosis. Spine 1989; 14: 379-86.

[20] 20. Kostuik JP, Carl A, Ferron S. Anterior zielke instrumentation for spinal deformity in adults. J Bone Joint Surg 1989;71A:898-912.

[21] 21. Hodge WA, DeWald RL. Splenic injury complicating the anterior thoracoabdominal surgical approach for scoliosis. J Bone Joint Surg 1983;665A:396-97.

[22] 22. Slawski OP, Bridwell KH, Manley CB. Acute renal obstruction after combined anterior and posterior athrodeses on the convex side of the spine. J Bone Joint Surg 1990;72A:l.259-61.

[23] 23. Bradford OS, Ahmed KB, Moe JH, et al. The surgical management of patients with Scheuermann's disease. J Bone Joint Surg 1980; 62: 705-12.

[24] 24. Flynn JC, Hoque MA. Anterior fusion of the lumbar spine. J Bone Joint Surg 1979;61A:l.143-50.

[25] 25. Smith TK, Stallone RJ, Yee JM. The thoracic surgeon and anterior spinal surgery. J Thorac Cardiovasc Surg 1979;77:925-28.

[26] 26. Burrington JD, Brown C, Wayne ER, Odom J. Anterior approach to the thoracolumbar spine. Arch Surg 1976;111:456-63.

[27] 27. Slye DA. Orthopedic complications. Nurs Clin North Am 1991; 26: 1.113-33.

Brasil

Brasil

Via de acesso para exposição ampla da coluna toracolombar anterior (T10 -L5)

Extensive anterior approach to the thoracolumbar spine (T10 -L5)

Resumos

Datas de Publicação

Histórico