Abstract
Purpose: Thoracoscopic spinal surgery may be less aggressive than classical open surgery. We relate our experience over the last five years, analysing complications observed.
Material and methods: Between 1995 and 2000, 68 patients underwent thoracoscopic spinal surgery. There were 34 men and 34 women, mean age 30.2 years (13–69). We analysed indications, preoperative anaesthesia parameters, peroperative and postoperative parameters and pulmonary, vascular, neurological and instrumental complications.
Results: Indications were: metastatic compression in three patients, disc herniation in eight with five calcified discs, fracture in 25, anterior release for scoliosis in 32 with inter-somatic graft in 20. Mean duration of the hospital stay was 19.6 days (7–48). There were three fractures with lung contusion that were excluded from the analysis although thoracoscopic surgery was possible. The analysis thus included 61 right and four left thoracoscopies. Four to nine trocars were used. There were three cases of intercostal nevralgia. Operation time depended on the underlying disease: 18 min for scoliosis, 2 hr 40 min for fractures, 4 hr 15 min for discal herniation (2 h 20–7 h 15). Blood loss was less than 200 cc for scoliosis, a mean 533 cc for fractures, and 800 cc for metastases. There were no pulmonary, vascular or instrumental complications. The image amplifier was used to monitor all osteosyntheses. We had one patient whose neurological situation worsened after resection of a transdural calcified thoracic herniation. Stay in the intensive care unit after surgery was 3.4 days, the drain was removed at 3.26 days and had collected 1240 cc. Postoperative paint was assessed for patients who had undergone thoracoscopy alone and who had no other disease (19 fractures and 8 herniation cases). level three antalgesics were required for 3.2 days. There were no vascular complications or signs of phlebitis. One residual atelectasia of the lower right lobe occurred in a female patient with major traumatic contusion, and pleural effusion was observed in three. One patient developed a contralateral pneumothorax that was punctured after release of major scoliosis (Cobe 92°). Residual pleural effusion after withdrawing the drain was aspirated at 48 hours. There were no infections.
Discussion: Thoracoscopy allowed the planned procedure in all patients. Blood loss was much lower than with classical open surgery. Pain was controlled better and the cosmetic effect was exceptional. Function was recovered rapidly by fracture patients. the quality of the anterior release for the scoliosis patients was equivalent to that obtained with classical techniques.
Conclusion: The complication rate was lower than that usually observed for similar procedures using classical techniques.
The abstracts were prepared by Pr. Jean-Pierre Courpied (General Secretary). Correspondence should be addressed to him at SOFCOT, 56 rue Boissonade, 75014 Paris, France
