Minimally Invasive Thoracolumbar Corpectomy and Stabilization for Unstable Burst Fractures Using Intraoperative Computed Tomography and Computer-Assisted Spinal Navigation

MINIMALLY INVASIVE LATERAL RETROPLEURAL APPROACH TO THE THORACOLUMBAR JUNCTION – REVIEW & EXPERIENCE

“…5 Scheufler et al also presented favorable clinical results, with significant reduction in morbidity and pain after surgery, early hospital discharge, and less postoperative immobility. 14 The technique used by this Service was similar to those applied by Uribe et al, 5 Park et al, 10 Scheufler et al, 11 Patel et al, 13 Payer et al, 14 and Yen et al 16 Yu et al 12 differed from the previous ones by using intraoperative computed tomography and navigation. Shi et al, 15 in turn, conducted a prospective randomized study with two different groups of patients, one of them submitted to retropleural access and the other transdiaphragmatic access, preserving the costal insertion of the diaphragm.…”

“…Cases of spondylodiscitis in the thoracolumbar junction or low thoracic spine can also be treated by means of this access, with the objective of local debridement to cure the infectious process, as well as favoring arthrodesis and preventing the emergence of post-infectious deformities. [10][11][12] While still in the preoperative period, the presence of contraindications relative to the technique in question, capable of compromising therapeutic success, have to be assessed. They include anomalies in the vascular anatomy (lateralized vessels in patients with deformities and rotation of the vertebral body, or positioning of the Adamkiewicz artery in the access path), vascular diseases, retroperitoneal or retropleural scarring from previous surgery, intense pleural inflammatory reaction secondary to infections (e.g.…”

“…[9][10][11] The technique proved to be viable in preliminary studies performed on cadavers 5 and subsequently in patients for the treatment of various conditions that affect the thoracolumbar junction, including the use of interbody spacers and instrumentation materials, such as plates and screws. 5,[10][11][12] Yu et al, used surgical navigation, reporting lower levels of radiation than those who used fluoroscopy. 12 Uribe et al, Park et al, and Scheufler et al reported, respectively, mean blood loss of 460 ml, 374 ml, and 280 ml; mean surgical time of 240 minutes, 124 minutes, and 163 minutes; and mean hospitalization time of 4.5 days, 3,5 days, and 7.4 days.…”

“…5,[10][11][12] Yu et al, used surgical navigation, reporting lower levels of radiation than those who used fluoroscopy. 12 Uribe et al, Park et al, and Scheufler et al reported, respectively, mean blood loss of 460 ml, 374 ml, and 280 ml; mean surgical time of 240 minutes, 124 minutes, and 163 minutes; and mean hospitalization time of 4.5 days, 3,5 days, and 7.4 days. Patients with tumors, fractures, and degenerative diseases were treated.…”

“…There are many possible complications that can result from the use of the open technique, including intense pain (caused by the extent of the incision, especially due to intercostal neuralgia) 12,[15][16][17][18] and injury to the parietal and pulmonary pleurae, which may lead to the need to use a chest tube, which makes the surgery more morbid and elevates the risk of respiratory tract infections. In the group presented by Shi et al 5 that underwent transdiaphragmatic access, twenty cases of pulmonary infection, 17 of atelectasis, 18 of encapsulated pleural effusion, and eight cases of paralytic ileus were identified.…”