To investigate the diagnostic properties of magnetic resonance imaging (MRI) scans in detecting surgically verified disruptions of the cervical intervertebral disc and anterior (ALL) and posterior longitudinal (PLL) ligaments.

Data were extracted from the reports of cervical spine MRI scans of patients who subsequently underwent surgical stabilization for presumed instability following disco-ligamentous injuries of the cervical spine. The level and severity of disc, ALL and PLL disruption was compared with surgical findings. Unweighted kappa statistics were used to assess agreement. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated after findings where dichotomised into complete rupture, yes/no. Sensitivity analyses were performed to account for missing data.

The MRI and surgical findings were compared on 31 consecutive patients. The kappa values for intervertebral disc disruption, ALL and PLL disruption were 0.22, 0.25 and 0.31 respectively, indicating fair agreement. Sensitivity, specificity, PPV and NPV are shown in Table 1. The false negative rates for diagnosing complete disruption of the disc, ALL and PLL were 0.18, 0.40 and 0.14 respectively.

The ability of cervical MRI scans to detect surgically verified disruptions of the intervertebral disc, ALL and PLL varied depending on the structure examined. In this series, the cervical MRI scan reliably detected disruption of the intervertebral disc disruption and ALL. The false negative rates are of concern and indicate the need for additional investigations to exclude instability in the absence of negative MRI findings.

Introduction: To evaluate a three-stage procedure for the correction of symptomatic post-traumatic kyphotic deformity of the thoracic or lumbar spine.

Methods: Over an 18-month period, five consecutive cases of post-traumatic kyphosis of the thoracic/lumbar spine were analysed. Indications for surgical correction were incapacitating back pain, progression of kyphotic deformity, persistent neurologic deficit and development of late spinal stenosis. All patients underwent a three-staged procedure using two surgeons. At first they were positioned prone for a posterior midline approach, with pedicle screw placement (USS), decompressive laminectomies and facetectomies. For the second stage, the patients were positioned either on left side (for upper thoracic spine) or on the right side (for the thora-columbar junction and lumbar spine). An open, minimal invasive access procedure using the SynFrame retractor was performed. The anterior column was reconstructed using expandable cages (Synex cages) with autologous bone for interbody fusion. Finally, the patient was again positioned prone for posterior compression, instrumentation and fusion.

Results: The five patients comprised four males and one female. Age range was 26–51 years. Level of injury was T7–L3. Time since injury was two to10 years. Mean operating time was eight hours. One patient required a thoracic pedicle screw revision and another a posterior deep wound infection requiring wound debridement and lavage. Follow-up period was three to 15 months. All patients reported improvement in pain post-operatively. Lower rates of pain improvement correlated with longer standing symptomatic injuries. No worsening of neurological deficit occurred.

Conclusion: Early correction of symptomatic kyphosis is recommended and aims to improve pain, deformity and function. Recognition of the correct type of injuries is essential to avoid late deformity. Correction of symptomatic post-traumatic kyphotic deformity is achieved by this three-staged approach. Minimal invasive anterior reconstruction using SynFrame and expandable Synex cages is safe and effective. Two surgeons working in conjunction is advantageous.

Introduction and Aims: To evaluate open, minimal invasive spine surgery (MISS) with video-assisted thoracoscopic surgery (VATS) using the SynFrame retractor and expandable cages for the anterior reconstruction of thoracic and lumbar spine injuries.

Method: Thirty-three consecutive cases of thoracic and lumbar spine pathology requiring anterior reconstruction were analysed. Most patients (90%) underwent prior posterior stabilisation using the Universal Spine System (USS). The thoracic spine was approached by a right-sided mini-thoracotomy, the thoraco-lumbar junction by a left-sided mini-thoracotomy and the lumbar spine by a left-sided mini-retroperitoneal approach using the table-mounted SynFrame retractor system. Fiberoptic endoscopes facilitated illumination and visualisation. The anterior column was reconstructed using expandable cages (Synex) with autologous bone for interbody fusion.

Results: Twenty-two males (67%) and 11 females (33%) underwent the procedures. Median age was 38 years (range 19–57). Pathology was trauma in 31 (94%) and tumor in two (6%) cases. Location was thoracic (34%) and lumbar (66%). Mean operating time was 150 minutes (range 75–195 min). Mean blood loss was 0.78 litres. Only three patients needed blood transfusions. Additional bone graft was generated from resected rib or harvested iliac crest in 70% of all cases. There were no visceral/vascular complications, intercostal neuralgia or post-thoracotomy pain syndromes from the minimal access. No anterior reconstruction infections occurred, but there was one superficial and two deep wound infections from the posterior stabilisation. Two cases were abandoned secondary to intercostal vessel bleeding without sequelae. Isolated spine injury cases had mean length of hospital stay of 10 days and return to work at 12 weeks post-operatively.

Conclusion: Open, minimal access to the anterior thoracic and lumbar spine is ‘pathology-independent’ and combines the advantages over ‘standard open’ and ‘pure’ endoscopic procedures. Major advantages are direct three-dimensional view of the spine for the surgeon, no need for double-lumen intubation, significant reduction in access morbidity, shorter hospital stay and earlier return to work.