Endoscopic surgery on the thoracolumbar junction of the spine

Abstract

The thoracolumbar junction is the section of the truncal spine most often affected by injuries. Acute instability with structural damage to the anterior load bearing spinal column and post-traumatic deformity represent the most frequent indications for surgery. In the past few years, endoscopic techniques for these indications have partially superseded the open procedures, which are associated with high access morbidity. The particular position of this section of the spine, which lies in the border area between the thoracic and abdominal cavities, makes it necessary in most cases to partially detach the diaphragm endoscopically in order to expose the operation site, and this also provides access to the retroperitoneal section of the thoracolumbar junction. A now standardised operating technique and instruments and implants specially developed for the endoscopic procedure, from angle stable plate and screw implants to endoscopically implantable vertebral body replacements, have gradually opened up the entire spectrum of anterior spine surgery to endoscopic techniques.

Thoracoscopic anterior stabilization for thoracolumbar fractures in patients without spinal cord injury: quality of life and long-term results

“…And although satisfactory results were obtained, the minimally invasive video-assisted thoracoscopy (VATS) technique provides advantages such as smaller incisions, no need for rib resection, excellent visualization and minimal surgical chest wall injury [13]. If stabilization with a cage is performed using VATS, a stable construction can be provided through a minimally invasive procedure to reduce surgical damage [13][14][15][16][17].…”

Minimally invasive surgery compared to open spinal fusion for the treatment of degenerative lumbar spine pathologies

“…Paraspinal muscle dissection involved in open spine surgery can cause muscular denervation, increased intramuscular pressure, ischaemia, necrosis and revascularisation injury resulting in muscle atrophy and scarring which is associated with prolonged postoperative pain and disability. [3][4][5][6][7][8][9][10][11][12] This approach-related morbidity is then often associated with lengthy hospital stays and significant costs. 13 Spinal fusion utilising muscle dilating approaches to minimise surgical incision length, surgical cavity size and the amount of iatrogenic soft-tissue injury associated with surgical spinal exposure, without compromising outcomes, is thus a desirable advance.…”

“…13 Spinal fusion utilising muscle dilating approaches to minimise surgical incision length, surgical cavity size and the amount of iatrogenic soft-tissue injury associated with surgical spinal exposure, without compromising outcomes, is thus a desirable advance. [3][4][5][6][7][8][9][10][11][12] The current trend favours minimally invasive surgery (MIS) of the spine due to lower complication rates and approach-related morbidity with minimal soft tissue trauma, reduced intraoperative blood loss and risk of transfusion, improved cosmesis, decreased postoperative pain and narcotic usage, shorter hospital stays, earlier mobilisation with faster return to work and thus reduced overall health care costs. 1,4,[6][7][8][9][13][14][15][16][17][18] However, to our knowledge there is no quality published articles showing that MIS is superior to open spinal surgery.…”

Tecniche chirurgiche video-assistite nel trattamento delle fratture toraco-lombari

“…Questo rende possibile inserire un trocar intratoracico nel seno costofrenico che, dopo incisione dell'inserzio- ne diaframmatica sul rachide, consente l'accesso alla sezione retroperitoneale della giunzione toraco-lombare, proprio sotto alla limitante inferiore di L2. Per raggiungere questo livello così caudale è necessaria un'incisione più lunga (circa 4-5 centimetri), mentre l'accesso su L1 generalmente richiede una incisione di 2-3 centimetri [4]. L'incisione delle inserzioni diaframmatiche è critica per il rischio di ernia diaframmatica post-operatoria.…”

“…Le prime pubblicazioni sull'argomento, a metà degli anni Novanta, descrivevano interventi miranti a rimuovere materiale discale [1][2][3], mediante accessi endoscopici al passaggio toraco-lombare analoghi a quelli che descriveremo in seguito. Questa rassegna del trattamento endoscopico dei traumi toraco-lombari si basa sull'esperienza personale di oltre 1200 interventi endoscopici sul rachide eseguiti negli ultimi 10 anni [4].…”