Thoracic and Lumbar Fractures: Mini-Open Anterior Fusion in 138 Patients

Background: Several surgical procedures have been recommended for the management of thoracic and lumbar fractures. Nowadays Mini- Open Anterior Fusion is reported to be a safe and effective alternative treatment for various spinal pathologies. Aim: The aim of this study is to report the outcome of 138 cases who underwent mini open thoraco-lumbar surgery for thoracic and lumbar fractures. Material and Methods: We performed a non-randomized retrospective analysis of the clinical outcome of 138 patients with 140 fractures who underwent mini open thoraco-lumbotomy surgery, between 2011 and 2016. Follow up periods were 6th weeks, 3rd and 6th months and also 1 year postoperatively. All the patients were operated with mini open thoraco/lumbotomy system (Syn-Frame). All of our patients with fractures, undervent posterior pedicle screw fixation prior to the anterior fusion just after the posterior fusion or a couple of days later (mean: 4.2; 2 to 7 days), depending on the general condition of patients. Thorax drainage was placed to all thoracotomy patients (63% to 87%). Results: Fractures of 13 cases were due to tumor metastasis, and the rest of them were due to acute fractures, spondylodiscitis. 87 cases had thoracic (T6-T12) and 51 cases had lumbar (L1-L5) fractures. Discussion: Several methods are being used in order to achieve safe, and minimaly invasive approach in cases with thoracolumbar pathologies. The complication rates of this procedure are similar to endoscopy assisted thoracotomy. Syn-Frame System allows the opportunity to perform even 2-3 levels corpectomy and stabilization through a 5 cm skin incision. It is possible to insert 4 or more retractors from all angles to form an area just over the level operation level, without dealing with aorta, lung, urethra or heart. Conclusion: We can estimate that this approach is safe, minimally invasive and effective besides reducing the pain and morbidity of conventional methods.

[1]  J. Garces,et al.  Mini-Open Thoracolumbar Corpectomy: Perioperative Outcomes and Hospital Cost Analysis Compared with Open Corpectomy. , 2017, World neurosurgery.

[2]  R. Fessler,et al.  Minimally Invasive Thoracic Corpectomy: Surgical Strategies for Malignancy, Trauma, and Complex Spinal Pathologies , 2012, Minimally invasive surgery.

[3]  Safdar N. Khan,et al.  Minimally invasive thoracolumbar corpectomy and reconstruction. , 2012, Orthopedics.

[4]  K. Schaser,et al.  Revision surgery for posterior stabilized thoracolumbar fracture using mini‐open anterior approach and expandable cage , 2010, Orthopaedic surgery.

[5]  C. Sottas,et al.  Mini-open anterior approach for corpectomy in the thoracolumbar spine. , 2008, Surgical neurology.

[6]  C. Bach,et al.  Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion , 2004, European Spine Journal.

[7]  Kevin T Foley,et al.  Minimally Invasive Lumbar Fusion , 2003, Spine.

[8]  R. Kalff,et al.  [Vertebral body replacement system Synex in unstable burst fractures of the thoracic and lumbar spine--a retrospective study with 30 patients]. , 2003, Zentralblatt fur Neurochirurgie.

[9]  L. Khoo,et al.  Thoracoscopic-assisted Treatment of Thoracic and Lumbar Fractures: A Series of 371 Consecutive Cases , 2002, Neurosurgery.

[10]  O. Gonschorek,et al.  Endoskopisch assistierte Rekonstruktion der thorakolumbalen Wirbelsäule in Bauchlage , 2002, Der Unfallchirurg.

[11]  T. Kossmann,et al.  The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine , 2001, European spine journal.

[12]  W. Mutschler,et al.  [Surgical treatment of injuries of the thoracolumbar transition. 2: Operation and roentgenologic findings]. , 2000, Der Unfallchirurg.

[13]  P. Hax,et al.  Operative Behandlung von Verletzungen des thorakolumbalen Übergangs Teil 2: Operation und röntgenologische Befunde , 2000, Der Unfallchirurg.

[14]  P. Hax,et al.  Operative Behandlung von Verletzungen des thorakolumbalen Übergangs , 1999, Der Unfallchirurg.

[15]  V. Rajaraman,et al.  Visceral and vascular complications resulting from anterior lumbar interbody fusion. , 1999, Journal of neurosurgery.

[16]  O. Schwarzenbach,et al.  Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with monosegmental fusion , 1999, European Spine Journal.

[17]  Mayer Hm.  A new microsurgical technique for minimally invasive anterior lumbar interbody fusion , 1997 .

[18]  M. Mayer.  A New Microsurgical Technique for Minimally Invasive Anterior Lumbar Interbody Fusion , 1997, Spine.

[19]  J. Stambough.  Posterior Instrumentation for Thoracolumbar Trauma , 1997, Clinical orthopaedics and related research.

[20]  A. Patwardhan,et al.  Instability of the Lumbar Burst Fracture and Limitations of Transpedicular Instrumentation , 1995, Spine.

[21]  M. Reardon,et al.  Vascular injury in anterior lumbar surgery. , 1993, Spine.

[22]  R. C. Duffield,et al.  Longitudinal Element Size Effect on Load Sharing, Internal Loads, and Fatigue Life of Tri‐Level Spinal Implant Constructs , 1993, Spine.

[23]  Y. E. Kim,et al.  An Analytical Investigation of the Mechanics of Spinal Instrumentation , 1988, Spine.

[24]  Ley Eb,et al.  Retroperitoneal approach to lumbar disc. , 1954 .

[25]  W. D. Thurston,et al.  Retroperitoneal approach to lumbar disc. , 1954, Rocky Mountain medical journal.

[26]  J. Tsuchiya,et al.  A NEW RADICAL OPERATION FOR POTT'S DISEASE , 1934 .