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.