Purpose of the study: The treatment of thoracolumbar fractures has evolved over the last five years with cementoplasty percutaneous osteosynthesis in addition to the gold standard orthopaedic or surgical treatments. This percutaneous method preserves muscles and maintains reduction to healing. The purpose of this work was to evaluate our results in traumatology patients after five years experience, deducting our current indications.

Material and methods: From February 2004 to February 2009, we included 60 patients with a type A or B2 thoracolumbar fracture free of neurological problems and who had more than 10° kyphosis. Reduction was achieved in hyperlordosis before the percutaneous procedure. In other cases we used open arthrodesis. This was a retrospective analysis of a consecutive monocentre series including 37 men and 23 women, mean age 37 years. The injury was L1 and T12 in the majority. Classification was A1 and A3 for the majority. Osteosynthesis was achieved with an aiming compass and radioscopy. A removable corset was used as needed. Reduction and position of the screws as well as need for a complementary anterior fixation were assessed on the postoperative scan. Clinically, follow-up measured pain and quality of life (VAS and Oswestry), radiographically, vertebral kyphosis.

Results: Mean follow-up was 24 months. At last follow-up, the VAS was 15/100 and the Oswestry 16/100. Material was removed in ten patients. Early in our experience one patient developed neurological problems postoperatively requiring revision surgery. Postoperative vertebral kyphosis was stable at three months and was sustained at two years. Body healing was successful in all cases. There were no cases of material failure.

Discussion: This is a reliable reproducible technique in the hands of a spinal surgeon. Material removal can be proposed about one year after implantation. After the age of 65 years, we favour cementoplasty. For others, we propose a sextant for A1, A2, A3 or B2 fractures with more than 15° vertebral kyphosis. This percutaneous material had major advantages for tumour surgery, for multiple injury patients and for traumatology (especially when a double approach is used).

Conclusion: Percutaneous osteosynthesis of vertebral fractures is now the gold standard for well defined indications. Two therapeutic fundamentals are reduction on the operative table and preservation of the muscle stock. These satisfactory results should be confirmed after removal of the implants.

Purpose of the study: Discectomy-anterior fusion has proven efficacy for many diseases of the cervical spine. Nevertheless, the loss of motion and the over-solicitation of adjacent levels are arguments in favor of disc replacement. This prospective study examined the early clinical and radiological results obtained in the first 41 patients treated with a new cervical disc prosthesis, Mobi-C.

Material and methods: A prospective multicentric clinical and radiological study is being conducted to analyze the safety and efficacy of Mobi-C for degenerative disease. Indications are radiculopathies due to discal herniation or foraminal osteophytic stenosis involving one or two levels from C3 to T1. An independent observer reviewed the patients. SF36, the Neck Disability Index, and a visual analogue scale for pain as well as radiographic mobility were noted.

Results: Mean age was 42 years (range 31–56 years). There were 23 men and 18 women. Eight patients had two disc replacements. Mean follow-up was six months (range 3–10 months). Mean operative time was 65 min, similar to operative time for fusion. Blood loss was 90 ml. NSAID were prescribed for the first 15 days. There were no intraopeartive complications and no revisions. Postoperative complications were minimal. There were no specific complications related to the prosthesis, its insertion or its function. The function and quality-of-life scores showed a significant improvement at last follow-up. Radiographically, motion was also improved in most patients.

Discussion: The early results on the safety and efficacy of this new cervical prosthesis are promising. Primary stability has been excellent and there have been no specific prosthesis-related complications. Furthermore, several operators have mentioned how easy it is to insert the Mobi-C.

Conclusion: The clinical results in terms of pain and function as well as the radiological results have been satisfactory both at the early and at the later assessments. Insertion of this prosthesis is a simple process, similar to insertion of an intersomatic cage, elements arguing in favor of a cervical disc prosthesis. Further follow-up will be needed to assess the long-term efficacy and possible effect on prevention of accelerated degeneration of the adjacent discs.

Recent developments focus on a minimal-invasive approach to the thoracic spine with thoracoscopy. Very often it is necessary to collapse the lung in order to expose the thoracic spine. This technique cannot be used on patients with reduced pulmonary capacity or pleural adhesions. We are trying to use a semi- open technique to combine the advantages of open and thoracoscopic surgery.

The semi-open technique requires a 5 cm incision over the 10th rib with or without partial removal of the rib and retropleural approach to the thoracolumbar spine. From this incision a retropleural insertion of the thoracoscope using an additional incision 2 ribs above the original incision can be performed if necessary. The vertebra and surrounding tissues are visualised by thoracoscope, all further necessary interventions as well as diaphragm splitting can be performed via the main approach. After trial operations on cadavers we performed a spondylodesis on 22 patients with fractures of the lower thoracic and upper lumbar spine using a semi-open technique.

With the above described incision we were able to expose all vertebrae from Th11 to L2 and to perform a splitting of the diaphragm. Two cases needed an intraoperative and one case a postoperative pleural drainage. The maximum blood loss was 200 ml, maximum operation time 180 min. No complications such as infections or malunion occurred during follow-up.

We conclude that the semi-open technique is combining the advantage of open and thoracoscopic surgery avoiding a collapse of the lung and reducing the number of pleural drainages. All levels of the thoracolumbar spine can be reached and a safe spondylodesis with minimal blood loss can be performed. However this technique is requiring a learning curve and should be preceded by animal or cadaver trial operations.

Purpose: The advent of lapaoscopic disectomy has made it possible to cure discal herniation with minimal trauma and no limitations on indications. We have adopted the technique described by J. Destandau since June 1998. The purpose of this work was to report our early results.

Material and methods: Forty patients were included in a period from June 1998 to August 2000. There were 24 men and 16 women, mean age 43 years (24–78). Eleven patients had an associated stenosis of the spinal canal. Accelerated rehabilitation was employed. Sitting and driving were allowed early.

Results: Mean follow-up was 13 months (2–27 months). Mean operative time was 63 minutes (30–150 min). Mean hospital stay was 3.92 days (2–10). There were 29 patients without stenosis of the lumbar canal. In this subgroup, outcome was excellent in 69%, good in 21% (six patients), fair in 3% (one patient), and poor in 7% (two patients). For the PROLO score, three patients were who were retreated were not included in the analysis. Outcome was excellent in 73% (19 patients), good in 12% (three patients), fair in 12% (three patients, and poor in 4% (one patient). In patients with lumbar canal stenosis, (eleven patients), three were reoperated for wider decompression; there was no haematoma. One patient was reoperated for deep infection. For the other patients the WADDELL score was excellent in five and good; in two the PROLO score was excellent in six and poor in one.

Discussion: The technique favoured a narrow approach. Shorter exposure preserved the anatomy, but for the three patients with an associated stenosis, reoperation was necessary for decompression. For the cases without complications, we noticed that recovery was very rapid, a finding which is exceptional with the conventional technique.

Conclusion: Our early experience with this technique has demonstrated that laparoscopic discectomy is feasible and safe. An associated stenosis is a limitation; we recommend systematic decompression in association with the discectomy.

Purpose: As proposed by Marnay, posterior fixation of the spine with self-stabilising forceps facilitates the operative procedure. These forceps enable lamolaminal, pediculolaminal, or pediculotransverse fixations. We developed a method for posterior fixation of the spine where a self-stabilising forceps links the lateral forceps hook to a medial hook allowing a bilateral hold on the segment for better fixation and correction. The aim of this work was to evaluate the contribution of the self-stabilising forceps compared with standard hooks during reduction movements.

Material and methods: Pull-out tests were conducted on five different holds using a supratransversal hook, a sublaminal hook, a pediculotransversal forceps, and a pediculolaminal forceps (Spine-Evolution), and a bipediculolaminal hook mounted on two vertebrae (Sofamor-Danek). The tests were performed on anatomic specimens. The test procedure was a reduction of a kyphosis of the upper part to the tested segment. Fourteen measurements were made for each implant.

Results: Pull-out force (N) was (mean, range): supratrans-versal hook (24, 8-40) < pediculotransvers forceps (154, 80-280) < supralaminal hook (360, 120–560) < pediculolam-inal forceps (491, 440–550) < bipediculolaminal forceps on two vertebrae (711, 400–800). The differences were significant.

Discussion: These results must be considered under the experimental conditions. Fixation with a supratransversal hook did not produce a reliable hold. The pediculotransversal forceps failed in one case due to fracture of a weak transversal mass. The supralaminal hook exhibited more consistent pull-out resistance. In most of the cases, pull-out occurred by fracture of the posterior arch. The bilateral self-stabilising forceps demonstrated the greatest pull-out resistance. During the five tests made with this forceps, the test was limited by the weakness of the osteosynthesis rods used so the maximal resistance to pull-out could not be measured (> 800 N).

Conclusion: The self-stabilising pediculolaminal forceps provides greater pull-out resistance than hooks alone. The self-stabilizing bipediculolaminal forceps allows a new surgical strategy for segmentary fixation with promising potential.