The lateral extracavitary approach to the thoracic and lumbar spine

The lateral extracavitary approach (LECA) is one of the most versatile approaches to the thoracic and lumbar spine. Among the posterior lateral approaches, it allows for the best access to the ventral surface of the dural sac for anterior decompression. It can be combined with laminectomy, transpedicular decompression, costotransversectomy, or a contralateral LECA to provide circumferential decompression of the spinal cord or cauda equina. After vertebrectomy for decompression, it allows for vertebral body replacement and anterior lateral fixation with plates. In addition, posterior instrumentation can be placed for stabilization. With modification, the LECA can be applied from T2 to S1 and up to three adjacent vertebrectomies can be performed. The LECA is a technically demanding procedure with a steep learning curve. Given its versatility, however, it should be in the repertoire of spinal procedures of any neurosurgeon who performs spinal tumor surgery.