The morbidity of an anterior thoracolumbar approach: adult spinal deformity patients with greater than five-year follow-up.

Study Design: Retrospective study.

Objective: To analyze the complications and patient satisfaction related to an anterior thoracolumbar approach in the treatment of adult spinal deformity.

Summary Of Background Data: There is no long-term follow-up data on the effects of an anterior thoracolumbar approach on adult spinal deformity patients.

Methods: A specific questionnaire was used to evaluate long-term follow-up (average, 10.3 years; range, 5-20.6) of 62 adult patients who underwent spinal deformity surgery performed through an anterior thoracolumbar approach. Twenty-six patients had over 10 years follow-up and 36 were between 5 and 10 years follow-up. The questionnaire was composed of detailed scar-related subquestions for pain, appearance, bulging, daily life, and patient's personal opinion of surgery. Postoperative Oswestry Disability Index (scores) were also obtained.

Results: The average age and number of anterior fusion levels were 47.9 (range, 20-74) and 5.6 (range, 2-12), respectively. Although 82.2% patients were satisfied with the results of their surgery, in general, many of the patients were dissatisfied with aspects related to their anterior incision. For the pain domain, 20 patients (32.3%, 6 with >10 years follow-up, 14 patients with 5 years follow-up) had pain over their thoracolumbar scar, which they rated as moderate to severe. Twenty-seven patients (43.5%) had bulging of their scar region, 4 were surgically indicated for repair, and 1 had multiple surgical repairs. Twelve patients (19.4%) felt they had a poor outcome related to the postoperative appearance of their anterior wound. Fifteen patients (24.2%) showed limitations in activities of daily living due to their anterior incision. Three patients with >10 years of follow-up and 4 with >5 years of follow-up felt they were getting worse. The average Oswestry Disability Index score was 25.0 +/- 16.3 (range, 0-52) postoperative.

Conclusion: This is the first long-term (minimum 5 years) follow-up study focusing on patient outcomes after an anterior thoracolumbar approach for adult spinal deformity treatment. This approach appears to be associated with an appreciable high rate of postoperative pain (32.3%), bulging (43.5%), and functional disturbance (24.2%). Therefore, surgeons should use caution when recommending this approach to future adult spinal deformity patients.