TECHNIQUE AND CLINICAL RESULTS OF MINIMALLY INVASIVE RECONSTRUCTION AND STABILIZATION OF THE THORACIC AND THORACOLUMBAR SPINE WITH EXPANDABLE CAGES AND VENTROLATERAL PLATE FIXATION
- 1 October 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 61 (4), 798-809
- https://doi.org/10.1227/01.neu.0000298909.01754.c5
Abstract
To evaluate the techniques of minimally invasive single- and multilevel corpectomy and reconstruction of the thoracic and thoracolumbar spine using expandable vertebral body replacement (VBR) cages and ventrolateral plate fixation (VPF) via anterolateral retropleural (ALRA) and combined thoracoabdominal approaches. 38 patients with spondylitis, traumatic or metastatic lesions of thoracic or thoracolumbar vertebrae T4 to L2 underwent spinal decompression and ventral column reconstruction with correction of spinal deformity by VBR and VPF via ALRA or a combined lateral extrapleural/extraperitoneal (extracoelomic) thoracolumbar approach (CLETA). Overall clinical and neurological outcome, operative time, blood loss, reduction of deformity, and postoperative pain were assessed during a mean follow-up period of 22.8 months. VBR and VPF were carried out successfully without conversion to conventional approaches in all patients. Mean operative time (ALRA, 163 +/- 33 min; CLETA, 175 +/- 39 min), mean blood loss (ALRA, 280 +/- 160 ml; CLETA, 420 +/- 250 ml), average correction (19.3 degrees), loss of correction of sagittal deformity (0.9 degrees), and clinical outcome compare favorably to the results reported for open and endoscopic techniques. Postoperative pain levels (mean visual analog scale score at 24 h, 2.7 +/- 0.9) and the incidence of postoperative pulmonary dysfunction (three out of 38 patients) were low. The average length of stay was 7.4 days. ALRA and CLETA obviate routine chest tube insertion, thus allowing for early postoperative ambulation (average, 1.1 d). Minimally invasive VBR and VPF conducted via minimally invasive approaches (ALRA or CLETA) yields favorable clinical results at least equal to conventional open surgery, with significant reductions in perioperative morbidity and pain, expedited ambulation, and early discharge from the hospital.Keywords
This publication has 28 references indexed in Scilit:
- Minimal Access Spinal Surgery (MASS) in Treating Thoracic Spine MetastasisSpine, 2006
- Anterior stabilization of three-column thoracolumbar spinal traumaJournal of Neurosurgery: Spine, 2006
- Anterior expandable strut cage replacement for osteoporotic thoracolumbar vertebral collapseJournal of Neurosurgery: Spine, 2006
- A biomechanical comparison of three anterior thoracolumbar implants after corpectomy: are two screws better than one?Journal of Neurosurgery: Spine, 2006
- Endoscopic medial parascapular approach to the thoracic spineSurgical Endoscopy, 2004
- Effectiveness of Titanium Mesh Cylindrical Cages in Anterior Column Reconstruction After Thoracic and Lumbar Vertebral Body ResectionSpine, 2003
- Video-Assisted Versus Open Anterior Lumbar Spine Fusion SurgerySpine, 2003
- Retropleural Approach to the Thoracic and Thoracolumbar SpineNeurosurgery, 1995
- A comprehensive classification of thoracic and lumbar injuriesEuropean Spine Journal, 1994
- Anterior Approach to the Thoraco-Lumbar Junction of the Spine by a Retroperitoneal-Extrapleural TechnicPublished by Ovid Technologies (Wolters Kluwer Health) ,1973