Evolution of the Lateral Extracavitary Approach to the Spine

Jason Lifshutz, M.D.; Zvi Lidar, M.D.; Dennis Maiman, M.D., Ph.D.


Neurosurg Focus. 2004;16(1) 

In This Article

Abstract and Introduction

The development of alternative approaches to spine disorders marked an evolutionary change in the methods by which surgeons address diseases that affect the ventral portion of the spine. From the advent of spinal surgery until quite recently, physicians used posterior approaches almost exclusively for the treatment of all pathological processes. Surgeons subsequently became frustrated and disenchanted with outcomes of patients with anterior vertebral body disease when these procedures were applied. This sentiment is best reflected in the surgical thought related to Pott disease. In this paper, the authors chart the development of an influential approach to the spine that is designed to address these issues: the lateral extracavitary approach. They trace its origins to early precursor procedures and follow its use in current practice for the treatment of a variety of spinal disorders. They also examine its applications, role, and continued importance in the age of minimally invasive surgery.

The evolution of spinal surgical practice has been driven by three primary goals: decompression, stabilization, and correction of deformity.[1] During the late 19th and early 20th centuries, surgical options for the treatment of lateral and paraspinal disease were limited. Ménard and Capener pioneered approaches for the treatment of Pott disease (tuberculosis of the spine); however, each of these procedures had its limitations and neither became popular. In 1976, Larson and his team at the Medical College of Wisconsin expanded on the work of the former two innovators. Larson's group defined a method in which the surgeon could safely approach lateral and anterior spine disease and perform posterior stabilization during the same procedure through the same incision. This procedure, called the "lateral extracavitary approach" was initially devised for the treatment of Pott disease and vertebral osteomyelitis (SJ Larson, personal communication, 2003).[12] During the past 30 years, this approach, along with modifications, has been used in the management of spinal disorders of the thoracic and lumbar spine due to trauma, neoplasm, degenerative disease, and infection.[2,3,5,7,8,9,12,13,15,17,19,20,21] In this article, we will review the evolution of this procedure from its inception to its current applications with minimally invasive technology.