Lateral extracavitary approach [Neurosurgery Wiki]

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====== Lateral extracavitary approach ======

Larson et al. 
((Larson SJ, Holst RA, Hemmy DC, et al. Lateral extracavitary approach to traumatic lesions of the [[thoracic]] and [[lumbar spine]]. J Neurosurg. 1976;45:628–37.)) 
described an aggressive lateral approach to the spine in [[1976]] called the “[[lateral extracavitary approach]]”.
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The lateral extracavitary approach (LECA) allows for broad visualization and circumferential [[spinal column reconstruction]]. However, early reports demonstrated significant complication rates, protracted operative times, and prolonged hospitalizations. More recent reports have highlighted concerns for subsidence, particularly with expandable cages. 

The LECA approach for [[anterior column]] reconstruction with static or expandable cages is an important surgical consideration with favorable surgical parameters and complication rates. Further, use of expandable cages may allow for reconstruction over a larger segment without increased risk of subsidence
((Holland CM, Bass DI, Gary MF, Howard BM, Refai D. Thoracic lateral
extracavitary corpectomy for anterior column reconstruction with expandable and
static titanium cages: Clinical outcomes and surgical considerations in a
consecutive case series. Clin Neurol Neurosurg. 2014 Dec 6;129C:37-43. doi:
10.1016/j.clineuro.2014.11.022. [Epub ahead of print] PubMed PMID: 25528373.)).

However, despite certain advantages, few surgeons perform the lateral extracavitary approach. It is generally time consuming.

In particular, in the thoracic spine, the classic [[lateral extracavitary approach]] provides a generous corridor for vertebral tumor resection and subsequent central cage placement once nerve roots are sacrificed.
((Schmidt MH, Larson SJ, Maiman DJ. The lateral extracavitary approach to the thoracic and lumbar spine. Neurosurg Clin N Am. 2004;15:437–41.))
((Snell BE, Nasr FF, Wolfla CE. Single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis: Surgical technique and results in 15 patients. Neurosurgery. 2006;58:ONS263–8. discussion ONS-269.)).