Anterior Decompressive and Stabilizing Surgery for Complicated Thoracic and Thoracolumbar Spinal Injuries

Abstract

To study the possibility of application of anterior decompressive and stabilizing operations in patients with complicated thoracic and thoracolumbar spine and spinal cord injury without prior posterior intervention. Material and Methods. Anterior decompressive and stabilizing operations in the thoracic and thoracolumbar spine were performed in 82 patients. Transpleural approach was used in 26 patients, transpleural transdiaphragmatic-in 46, and retroperitoneal subdiaphragmatic approach-in 10 patients. Decompression of the spinal cord was accomplished by means of subtotal resection of damaged vertebral bodies. The defect after removal of the fractured vertebral body was filled with a porous NiTi implant in 41 cases, with reinforced NiTi implant in 27 patients, and with the unique expandable NiTi implant-in 14 patients. The Vantage fixation plate added in all cases allowed manipulation of vertebrae along all axes in all directions. Results. A good regression of neurological symptoms was obtained in 28.0 % of patients, and satisfactory-in 48.9 %. Neurological deficit remained unchanged in 23.0 % of operated patients. No technique-related complications were registered. Reinforcement of porous implant with titanium rod significantly increased the interbody fusion solidity. Conclusion. Anterior decompressive and stabilizing surgery for thoracic and thoracolumbar spine and spinal cord injury provides complete decompression of the spinal cord, one-stage reduction, reclination of the spine and correction of its axis, and complete interbody fusion with porous titanium-nickel implants in combination with the Vantage fixation plate.

Surgical Treatment of Subarachnoid-Pleural Fistula

“…Луцика с соавт. [2], протрузии и пролапсы грудных межпозвонковых дисков составляют всего 0,5 % от всех грыж дисков всех локализаций.…”