Introduction and purpose: The anterior approach to the spinal column has revolutionised this field of surgery. The purpose of this retrospective study is to assess the use of this route and its complications throughout three decades in our unit.

Materials and methods: We carried out a retrospective study of 608 patients who underwent surgery via the anterior spinal approach between 1972 and 2002. The mean age was 22.60 ±12.65 [2–74] with a sex distribution of 274/334 male/female (ratio 1.2). Both variables (mean age and gender) can be explained in that most of the operations were for scoliosis (58%). Different surgical approaches were used. Among the most common were thoracophrenolumbotomy (52.6%) and thoracotomy (36.5%), with predominance of the left side (63.8%). The most commonly used surgical procedure was discectomy with non-instrumented spinal fusion (53%) and with instrumentation (32%).

Results: A total of 13.8% presented complications associated with the anterior approach. The most common were thoracic: pleural effusion and atelectasis. The most severe complications were large vessel lesions, splenectomy, nephrectomy, Claude-Bernard-Horner syndrome and transient paraplegia. Only three patients required revision surgery. Six patients died (0.98%) and perioperative morbidity was 16.28%.

Discussion: The anterior approach has been consolidated as a valid, effective alternative in surgical treatment of the spinal column. Complications are not uncommon but usually not serious. We recommend the use of this technique to provide a wide range of therapeutic options in the field of spinal surgery.

Purpose: To review the sagittal lumbar and clinical profile of the two surgical procedures: TLIF (transforaminal lumbar interbody fusion and ALIF (anterior lumbar interbody fusion).

Materials and methods: We carried out a retrospective study of 46 patients who underwent circumferential fusion in 2000–2001. TLIF was used in the first group (21) and ALIF in the second (25). The posterior approach with pedicle instrumentation was used in all patients. Lateral radiographs of the lumbar spine in neutral position and bipedestation were used for evaluation before and after surgery and during follow-up. The results were compared statistically using the Wilcoxon matched pairs test.

Results: Lumbar lordosis was achieved with both techniques: TLIF+PF(posterior fusion) −33° (preoperative), −46° (postoperative) and ALIF+ PF −49° (preoperative), −54° (postoperative). However the height of the disc improved significantly with the anterior approach: TLIF+ PF 0.62 (preoperative), 1.35 (postoperative) and ALIF+PF 1 (preoperative), 4.65 (postoperative).

The duration of surgery, blood loss and hospital stay were greater with ALIF+PF than with TLIF+PF.

Conclusions: TLIF+PF has clinical and economic advantages over ALIF+PF. Lumbar lordosis and the area of instrumented lordosis was achieved with both circumferential fusion procedures and the only radiographic difference was the restoration of the disc height with ALIF.

Introduction: Most hospitals that treat patients with Pectus Excavatum use the pectus bar designed by D. Nuss. In essence, chest elevation is achieved by using a previously moulded steel bar.

It is relatively safe since the introduction of thoracoscopy, although there is a risk of injury to the heart.

Our group has attempted to diminish this risk by means of sternal traction using a clamp specially designed for use with a thorascope anchored in the cancellous tissue of the sternum.

Materials and methods: We used a tailored clamp in three consecutive patients aged 8, 12 and 15 with Pectus Excavatum Haller index > 7.

Procedure: Thorascopy was performed for a good assessment of the rib cage. Under direct vision, we inserted one arm of the clamp underneath the sternum at the deepest point of the defect about 5 cm to the right of the midline. With the other arm of the clamp we grasped the anterior side of the sternum percutaneously. When the clamp was closed, we could raise the sternum to increase the mediastinal space.

Results: The sternal elevation was satisfactory. Using thorascopy during the procedure enhanced safety and the additional time was a few minutes.

Conclusions: Correction of pectus excavatum is indicated for aesthetic purposes in many patients and the absence of severe complications is a goal. The sternal elevation described here (although it is only a preliminary study) is fast, economical and appears to make the Nuss procedure safer.