complete facetectomy, or lateral transpsoas

tumor control, and eventually disease control. The treatment strategy is mainly dependent on tumor histology. Each differential diagnosis of a

mary benign tumors [ 24 , 32 ]. Many studies have demonstrated that en bloc spondylectomy pro­vides a higher rate of tumor control, a lower rate of recurrence, and a longer term of disease-free survival for primary malignant vertebral tumors [ 5 , 9 , 11 , 49 , 70 , 72 – 74 ]. Boriani et al. reported a lower recurrence rate (22.4 %) following en bloc resection compared to non-en bloc resection (100 %) for chondrosarcoma [ 5 ]. In a study by Talac et al., a signifi cant lower recurrence rate (11 %) following “en bloc resection with negative margin” was noted, compared to “piecemeal resection with negative margin” (33 %) and “resection with positive margin” (70 %) for pri­mary sarcoma [

73 ]. Sciubba et al. published a

For metastatic tumors of the spine, surgical management can be effective in the relief of symptoms and in the improvement of life quality. Surgical decompression or evacuation of the tumor mass could provide better pain control, regain or maintain mobility, and offer improved sphincter control [

The development of MIS approaches to the thoracolumbar spine aimed to alleviate the sig­nifi cant approach-related morbidities in conven­tional open surgery. Apparently, this is the trend of spine surgery development, since MIS approaches allow less muscle and soft-tissue destruction, reduce blood loss, minimize postop­erative pain, shorten hospital stays, and facilitate early mobilization [

54 ]. To date, the MIS lateral

Thoracolumbar trauma patients present unique challenges to the spine surgeon, whose goals are to prevent primary or secondary neurological injury, enhance neurological recovery, stabilize the spine to promote early mobilization, and min­imize surgical morbidity. Minimally invasive sur­gery (MIS) has become a key tool in the spine surgeon’s armamentarium in the treatment of these potentially fragile patients, as it affords an alternative to traditional open procedures and their associated increased blood loss and infec­tion rates [ 1 , 2 ]. Specifi cally, lateral minimally invasive spine surgery (MISS) has recently become a treatment option in this patient popula­tion. The development of minimally invasive techniques potentially allows surgeons to better treat spine trauma patients by providing early decompression or stabilization while minimizing the morbidity of surgery. In this chapter, the epi­demiology of thoracolumbar spinal cord injuries will be discussed, followed by the indications for

during their second or third decade of life and often result from high energy trauma, such as motor vehicle accidents or falls from height [ 6 ]. Thoracolumbar injuries often result in signifi cant incurred costs to the individual and society, including the cost of treatment and lost produc­tivity. The incidence of neurologic injury for these cases ranges from 10 to 75 %, and those sustaining incomplete neurologic injuries have some potential for functional recovery [ 7 ]. Approximately 19.4 % of burst fractures are asso­ciated with a neurologic defi cit, especially in those fractures with more than 33 % spinal canal

Several factors should be considered when choos­ing the optimal approach for treating thoracolum­bar fractures, including the bony and/or ligamentous injury pattern, neurologic status, experience of the treating team, medical comor­bidities, body habitus, baseline level of function, prior history of radiation or surgery, and the con­dition of the soft tissues. Relative indications for an anterior approach include severe vertebral body comminution, incomplete neurologic defi ­cit, and secondary neural compression following posterior realignment and stabilization for a frac­ture dislocation associated with a burst fracture. In a study by Sasso et al., 91 % of patients with incomplete injuries improved at least one modi­fi ed Frankel grade, and 95 % appeared to achieve stable arthrodesis after anterior decompression and reconstruction [ 9 ]. Compared to posterior or lateral decompression, anterior decompression for thoracolumbar spine fractures with incom­plete neurologic defi cits resulted in a higher rate of neurologic improvement and recovery of bowel and bladder control [ to suggest that an anterior approach for incom­plete injuries results in better neurologic recovery compared to a posterior approach due to enhanced visualization and the ability to perform a better decompression [ 11 ]. Esses et al. found canal compromise improved from 44.5 to 16.5 % com­pared to 58 to 4 % when treated with posterior distraction versus anterior decompression and instrumentation, respectively [ also confi rmed the ability to achieve and main­tain correction of posttraumatic kyphosis with an

peritoneal approaches carry signifi cant morbidities, as well. Due to the complications outlined above, surgeons have sought less invasive surgical options that achieve the same operative goals, but with lower morbidity [ 26 – 33 ].

spine has been utilized by surgeons to access both the disk space and the vertebral body for a variety of lumbar degenerative conditions. With the development of surgical tools for the lateral tech­nique, the creation of a safe surgical working zone allows the surgeon to target a specifi c vertebral body fracture, decompress the spinal canal, place a structural device with bone graft, and safely place instrumentation to stabilize the spine.

42 ], but more

Smith et al. [ 2 ] investigated the use of MISS lateral techniques in the treatment of thoracolum­bar fractures. The study included 52 patients with thoracolumbar fractures that were treated with mini-open, lateral corpectomies with anterolat­eral plating or percutaneous transpedicular screws to supplement fi xation. The median oper­ative time was 128 min compared to 210–617 min for open surgery [ approach had signifi cantly lower blood loss of 300 ml compared to 2–3 l in open surgery [ 43 , 44 ]. This study showed an acceptable complica- tion rate of 15 % versus literature values that vary widely for open procedures [ 45 ]. The median length of stay in the hospital was 4 days com­pared to the reported 10–35 days for open sur­gery [ 5 , 46 ]. There was no signifi cant difference in outcome between the anterolateral plating and