Simultaneous anterior and posterior approaches to the spine for revision surgery: current indications and techniques

Revision spinal surgery often requires attention to both the anterior and the posterior portions of the spine. Staged, sequential, and more recently simultaneous anterior and posterior approaches have been proposed. A simultaneous approach has the distinct advantage of allowing complete and constant control of the anterior and posterior portions of the spine during surgery. The simultaneous approach has been shown to offer decreased operating time, blood loss, complication rate, and hospital length of stay as compared with staged procedures. The evolution in spinal instrumentation and ancillary equipment has greatly advanced the simultaneous technique. The development of a special operating table has facilitated patient positioning and intraoperative patient adjustments, optimizing operative exposure for the anterior and posterior surgical teams. The two-rod and four-rod techniques offer the surgeon the possibility to safely address complex deformities, particularly in kyphosis.