[Lateral retropleural and retrodiaphragmatic approach in patients with spine trauma and diseases: a systematic review and meta-analysis]

Mini-Open Intercostal Retroperitoneal Approach for Upper Lumbar Spine Lateral Interbody Fusion

OBJECTIVE

Conventional oblique lumbar interbody fusion (OLIF) approach is possible from the L2/3 to L4/5 levels. However, obstruction of the lower ribs (10th-12th) makes it difficult to maintain disc parallel maneuvers or orthogonal maneuvers. To overcome these limitations, we proposed an intercostal retroperitoneal (ICRP) approach to access the upper lumbar spine. This method does not expose the parietal pleura or require rib resection and employs a small incision.

METHODS

We enrolled patients who underwent a lateral interbody procedure on the upper lumbar spine (L1/2/3). We compared the incidence of endplate injury between conventional OLIF and ICRP approaches. In addition, by measuring the rib line, the difference in endplate injury according to rib location and approach was analyzed. We also analyzed the previous period (2018-2021) and the year 2022, when the ICRP has been actively applied.

RESULTS

A total of 121 patients underwent lateral interbody fusion to the upper lumbar spine (OLIF approach, 99 patients; ICRP approach, 22 patients). Endplate injuries occurred in 34 of 99 (34.3%) and 2 of 22 patients (9.1%) during the conventional and ICRP approaches, respectively (p = 0.037; odds ratio, 5.23). When the rib line was located at the L2/3 disc or L3 body, the endplate injury rate was 52.6% (20 of 38) for the OLIF approach but 15.4% (2 of 13) for the ICRP approach. Since 2022, the proportion of OLIF including L1/2/3 levels has increased 2.9-fold.

CONCLUSION

The ICRP approach is effective in reducing the incidence of endplate injury in patients with a relatively lower rib line, without pleural exposure or rib resection.

Clinical Application of Thoracoscopic Resection of Anterior Mediastinal Tumors under the Xiphoid Process

Objective

To explore the feasibility and advantages of thoracoscopic resection of anterior mediastinal tumors through subxiphoid and lateral thoracic approaches.

Method

74 patients with anterior mediastinal tumors hospitalized in our hospital from January 2019 to January 2022 were retrospectively analyzed. They were divided into the lateral chest group (31 cases) and the infraxiphoid group (43 cases) according to different operation methods. The tumor size, operation time, intraoperative bleeding, postoperative pain score, postoperative complications, postoperative drainage tube removal time, and hospital stay were compared between the two groups.

Result

The intraoperative bleeding and postoperative pain scores in the subxiphoid group were better than those in the lateral chest group. There was no significant difference in operation time and postoperative complications between the two groups.

Conclusion

Compared with the lateral thoracic approach, the thoracoscopic subxiphoid approach can be more safe and effective in resectioning anterior mediastinal tumors.