Background
Traditional diaphragmatic incision to expose the thoracolumbar junction is associated with significant morbidity. In an effort to eliminate the drawbacks during and after thoracolumbar exposure, the technique of diaphragmatic mobilization has been developed to expose T12, L1 and upper L2 vertebral bodies.
Objective
The objective of this study was to demonstrate the feasibility and clinical experience of diaphragmatic mobilization technique to the thoracolumbar junction.
Materials and methods
Seventeen patients with spinal pathology at the thoracolumbar junction (T12, L1 and L2) underwent surgery using left-sided thoracotomy with diaphragmatic mobilization. In each case, the lateral aspect of the involved vertebra with the disc space proximal and distal was exposed with the mid-vertebra proximal and distal. Preoperative and intraoperative fluoroscopy was used to assure correct level together with daily postoperative chest radiography until chest drain removal. Operative results, complications and early outcomes were assessed.
Conclusion
Diaphragmatic mobilization allowed adequate thoracolumbar exposure to perform corpectomy, decompression and strut grafting plus or minus fixation without the need for circumferential release, thus avoiding its possible complications. In addition, it can be considered as an alternative for surgeons lacking experience, or facilities with video-assisted thoracoscopic surgery.