Abstract
Introduction: Video assisted thoracoscopic surgery (VATS) is associated with good correction ability for spinal deformity and allow the reconstruction of the anterior column of the spine in tumors, deformity and trauma cases. Stand alone and instrumented procedures are possible. VATS has shown to be safe and can reduce the morbidities of traditional open anterior surgery but is a technically demanding procedure with a steep learning curve. The potential technique-related complication rate is low in experienced hands.
Material and Methods: From 2006 till today, 22 thoracic vertebral fractures have been treated with thoracoscopic approach. The mean patients age was 32 years (24–58) and the levels treated between T6 and L1.
Five fractures required only anterior approach, with corpectomy, implantation of an expandable cage (Obelisk, Ulrich, Germany) with autologous bone graft and an anterior Macs TL plate (Aesculap, Germany). The others seventeen fractures were treated by combined anterior – posterior approach in the same operating session or, the second, previously performed immediately after the admission.
The endoscopic splitting of the diaphragm was performed in 9 cases to expose the L1/L2 levels.
Seven patients received decompressive laminectomy during the first posterior approach performed in emergency settings. Endoscopic anterior decompression was required in 5 cases. One thoracic drainage was inserted and removed on third day in most cases.
Results: The thoracoscopic approach allowed a reduction of blood loss, better pulmonary function, an earlier mobilization of the patients and a shorter hospital stay. With the experience the duration of surgical time decreased of one third. The mean duration of the procedure was 190 minutes and the blood loss of 220 ml.
There were no major complications. In the first group of 8 cases a delayed removal of the thoracic drain and three conversion in open thoracotomy occurred. The patients were radiologically evaluated for bony fusion, sagittal alignement and by VAS and Oswestry scale for the overall satisfaction about the treatment.
The mean follow-up time was 10 months (4–32). We didn’t found any loss of correction more than 5 degree.
Conclusion: VATS permits a better visualization of the anatomic structures and allows the same reconstruction capabilities of the open technique with a faster recovery, a shorter hospitalization and a better cosmetic results.
We observed a significant reduction in postoperative pain and drugs delivered for it.
The clinical results have been encouraging. We believe that this technique can be a valuable tool in the management of the thoracolumbar fractures with acceptable morbidity and a little impact of pulmonary function. A careful selection of the patients scheduled for anterior stand alone procedure is required to avoid the risk of failure of the instrumentation.
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