2025 Volume 16 Issue 7 Pages 940-950
Introduction: The thoracolumbar junction (TLJ) presents considerable anatomical challenges during spinal surgery, often requiring access through the chest cavity or diaphragm. Conventional approaches have inherent limitations, including increased morbidity and technical difficulties owing to the substantial distance from the skin incision to the vertebral body and interference from the ribs, leading to ergonomic challenges. We developed a Reverse Oblique Approach (ROA) to address these issues.
Methods: We conducted a retrospective comparative study involving 38 patients who underwent either corpectomy or lateral interbody fusion (LIF) at the TLJ using either a conventional or Reverse Oblique Approach. Individuals with thoracolumbar pathologies requiring anterior access were included in the study. We evaluated the operative time and the incidence of parietal pleural injury.
Results: In the corpectomy cohort, six patients underwent conventional approaches, while six patients underwent the Reverse Oblique Approach. Despite the greater complexity of surgeries in the ROA group, the mean operative time was shorter (183.66±20.89 minutes) compared to the conventional group (211.17±25.34 min), though the difference was not statistically significant (P = 0.18). Parietal pleural injury occurred in 50% of the patients in the conventional group compared to 16.7% in the ROA group.
In the LIF cohort, 13 patients underwent conventional approaches and 13 underwent ROA. The ROA group had a significantly shorter mean operative time (140.31±52.13 min) compared to the conventional group (174.92±29.72 min; P = 0.048), with no significant difference in the number of levels operated (P = 0.68). Postoperative pleural effusion was observed in 46.2% of the patients in the conventional group and in 30.8% of the patients in the ROA group. One case of permanent left phrenic nerve palsy was observed in the control group.
Conclusions: The Reverse Oblique Approach is a viable alternative to conventional techniques for TLJ surgery, resulting in a reduced operative time, lower rates of pleural injury, and fewer postoperative complications, even in complex cases. These findings suggest that ROA may serve as a valuable minimally invasive approach to achieve a favourable balance between operative accessibility and surgical safety.
