Abstract
Introduction and Aims: To evaluate open, minimal invasive spine surgery (MISS) with video-assisted thoracoscopic surgery (VATS) using the SynFrame retractor and expandable cages for the anterior reconstruction of thoracic and lumbar spine injuries.
Method: Thirty-three consecutive cases of thoracic and lumbar spine pathology requiring anterior reconstruction were analysed. Most patients (90%) underwent prior posterior stabilisation using the Universal Spine System (USS). The thoracic spine was approached by a right-sided mini-thoracotomy, the thoraco-lumbar junction by a left-sided mini-thoracotomy and the lumbar spine by a left-sided mini-retroperitoneal approach using the table-mounted SynFrame retractor system. Fiberoptic endoscopes facilitated illumination and visualisation. The anterior column was reconstructed using expandable cages (Synex) with autologous bone for interbody fusion.
Results: Twenty-two males (67%) and 11 females (33%) underwent the procedures. Median age was 38 years (range 19–57). Pathology was trauma in 31 (94%) and tumor in two (6%) cases. Location was thoracic (34%) and lumbar (66%). Mean operating time was 150 minutes (range 75–195 min). Mean blood loss was 0.78 litres. Only three patients needed blood transfusions. Additional bone graft was generated from resected rib or harvested iliac crest in 70% of all cases. There were no visceral/vascular complications, intercostal neuralgia or post-thoracotomy pain syndromes from the minimal access. No anterior reconstruction infections occurred, but there was one superficial and two deep wound infections from the posterior stabilisation. Two cases were abandoned secondary to intercostal vessel bleeding without sequelae. Isolated spine injury cases had mean length of hospital stay of 10 days and return to work at 12 weeks post-operatively.
Conclusion: Open, minimal access to the anterior thoracic and lumbar spine is ‘pathology-independent’ and combines the advantages over ‘standard open’ and ‘pure’ endoscopic procedures. Major advantages are direct three-dimensional view of the spine for the surgeon, no need for double-lumen intubation, significant reduction in access morbidity, shorter hospital stay and earlier return to work.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
One or more of the authors are receiving or have received material benefits or support from a commercial source.
