THORACOSCOPICALLY-IMPLANTABLE TELESCOPIC VERTEBRAL BODY REPLACEMENT CAGE FOR TREATMENT OF THORACOLUMBAR FRACTURES

Abstract

Introduction: Introduction of the minimal invasive surgery as a new concept in spinal surgery necessitated the need for implants that can be applied through minimal invasive approaches. One of the great challenges was the development of anterior minimal invasive vertebral replacement implants that are mechanically fit and easily applicable. Many studies were concerned with the early results of such implants but not yet the long-term or late ones.

Methods: Between January 2003 and December 2003 we have operated 23 patients (13 males and 10 females) with traumatic thoracic or thoracolumbar fractures that were indicated for corpectomy. In addition to posterior transpedicular instrumentation, anterior thoracoscopically assisted corpectomy and reconstruction using a telescopic vertebral body replacement cage was done in all patients. Patients were operated either in one or two sittings. Preoperative complete clinical, neurological and radiological evaluation was done. Postoperatively, clinical and radiological outcomes were evaluated, including postoperative neurological improvement, ODI (Oswestry Disability Index) and fusion rate. The average follow up period was 4 years.

Results: Fusion rate was 100% at the final follow up. The mean age was 52.5 years. 6 patients had preoperative neurological deficits varying from Frankel B to Frankel A that were improved postoperatively in 5 cases and not improved in one case. The average corpectomy time was 148 minutes (range 75–240 min.). The average ODI was 8.6 (range 0 – 31). Postoperative complications included wound healing problems in one patient, psoas abscess in one patient and pulmonary embolism in one patient. The average preoperative kyphosis (Cobb angle) was 22.43 that were improved to 7.28 degrees postoperatively, and it was 11.8 degrees at the final follow up. Considerable cage sinking (more than 5 mm) was detected in two cases.

Conclusion: Vertebral body replacement cage that can be thoracoscopically applied is a good solution for ventral implants in cases of thoracolumbar fractures that required corpectomy. It showed good early as well as 4 years follow up results.

Study Type: Prospective observational study