FIVE-YEAR OUTCOMES AFTER THORACOSCOPIC VENTRAL SPONDYLODESIS OF INCOMPLETE BURST FRACTURES OF THE THORACOLUMBAL SPINE

Abstract

Introduction: The ventral thoracoscopic spondylodesis of the thoracolumbal spine is an elegant treatment strategy in cases of incomplete vertebral burst fractures.

Materials and Methods: In the years 2002/03 29 patients with incomplete burst fractures of the thoracolumbal spine, were treated by a ventral thoracoscopic spondylodesis and were included prospectively. The individual treatment plan depended on the patient’s general condition and the vertebral stability. The data acquisition was done according the DGU guidelines of documentation preoperative, postoperative, and after 3, 6, 12, and 18 months. After 5 years a follow-up examination was performed in 21 of these patients (9 men, 12 women, average age: 46.3 years, follow-up rate: 72%). 9 patients were treated ventral only. In all of them the ventral spondylodesis was done monosegmental with autologous iliac crest. In 12 cases a dorsoventral procedure was performed, 5 patients ventral monosegmental with iliac crest, and 7 patients bisegmental with cage. Parameters of interest were the bisegmental kyphotic angle, the SF-36 score, the visual analogue scale (VAS), and the morbidity of the surgical approach.

Results: The 5-year results of the 21 patients dependent on the treatment strategy:

• 5 years/Reposition- Loss of Reposition- VAS- PSC (SF36)- MCS (SF36)

• Ventral only/3,4°- 2,5°- 72- 48- 55-

• Dorso-ventral (total)/7,1°- 6,0°- 79- 49- 50

• Ventral monosegmental/9,8°- 5,2°- 81- 54- 54

• Ventral bisegmental/4,5°- 6,3°- 77- 44- 56

Only three patients complained of intermittent weak pain sensation at the region of the thoracoscopic approach (14%). During the 5 years one revision surgery was performed because of the development of an incisional hernia.

The computertomographic controls of the 14 patients who gained a monosegmental spondylodesis with an iliac crest showed in 12 cases a complete osseous consolidation (86%) after 5 years. In the other two cases the osseous consolidation was only partly visible with an area of consolidation of more than 30% (14%). In both cases a sufficient stability was existent. 4 patients (29%) had no symptoms at the site of the iliac crest removal. 8 patients (57%) reported of weak residual pain, 2 patients (14%) reported of more intense pain sensation.

Conclusions: After 5 years the ventral thoracoscopic spondylodesis of the throracolumbar spine after incomplete burst fractures prove to be a save and successful therapy strategy. There are no significant differences between the isolated ventral spondylodesis and the dorsoventral spondylodesis in respect of loss of reposition of the bisegmental angle, persisting pain sensations, and quality of life after 5 years. The ventral thoracoscopic monosegmental spondylodesis seems to be by trend superior to the bisegmental strategy in respect of the physical summary score.