Abstract
Introduction
Significant access morbidity with intercostal neuralgia and post-thoracotomy pain syndrome was reported in case that an anterior approach for spondylodesis of fractures of the thoracolumbar spine was used. We describe our experience with thoracoscopical fusion from anterior as a less invasive approach.
Patients
Between 02/2007 and 09/2008 in a series of 32 patients (18 male; mean age 43, 17–74yrs) with fractures of the thoracolumbar spine (level Th11: n = 2, level Th12: n = 12, level L1: n = 18; fracture types: A3.1.1: n = 15, A3.2.1: n = 11, A3.3.1: n = 3, B2.1: n = 1 and B2.3: n = 2) thoracoscopical fracture stabilization was performed. A less invasive approach with three portals without an assistant was used facilitated by a new retractor system. In 16 patients fracture stabilization from anterior was supported by an additional spondylodesis using an dorsal approach. For reconstruction of the anterior column a VLIFT-system (n = 19), a Synex- (n = 11) or a Harms-Cage (n = 2) in combination with a MACS-TL (n = 16) or a Arcofix-system (n = 2) were used.
Results
Thoracoscopical fusion from anterior was performed about 8 days after the injury (1–73 days), monosegmental in 11 and bisegmental in 21 out of 32 cases. The mean overall operating time was 201min (range 105–380min). The mean overall blood loss was 780ml, in 3/32 patients blood transfusions were required. In one patient epidural bleeding and in another a screw cut-out of the MACS system of the first lumbar vertebral body occurred intraoperatively. Revision surgery was necessary due to failure of the hardware (n = 2) or occurrence of hematothorax (n = 1). In the further follow up period no wound healing disorders, failure of the implants nor intercostal neuralgia were noted.
Discussion
The endoscopic view is two-dimensional and may disorientate the less experienced surgeon, and thus, prolong operation time. However, the use of a retractor system allowed for bimanual operation increasing the depth perception, provided an optimal illuminated, and permanent and stable operation field, and was economic as an assistant was not required.
Conclusion
The presented technique is a high demanding approach for anterior fusion of fractures of the thoracolumbar spine, however, with the potential to reduce the surgical access trauma to a minimum with an operation time comparable to open surgery. Patients might benefit from a shortened rehabilitation and a early reintegration into professional life.
