Minimally invasive ventral spondylodesis for thoracolumbar fracture treatment: surgical technique and first clinical outcome

Abstract

IntroductionMinimally invasive techniques are becoming more widespread in the surgical subspecialties. Standard open surgical procedures are being modified to become less invasive, with the intention of reducing recovery time, morbidity, and ultimately expenditure. Improvements in technology have allowed the surgeon to enter body cavities and create potential spaces such as the retroperitoneum by diaphragm splitting. Improved fiber optics, light sources, and use of 30°angled optic cameras have resulted in improved visualization of the structures surrounding the spine [1,3,4,5,6,7,8,9,10,11,13,15,16,17,18,20,21,22,23]. Indications for endoscopic spinal surgery are degenerative diseases, infection, tumor, fracture, and ventral release for scoliosis and kyphosis. This minimally incisional technique provides a feasible alternative to thoracotomy or posterolateral approaches for decompression and vertebral body reconstruction. Long distance overbridging by strut graft and stabilization plays an important role, especially in cases of fracture treatment with the need for spinal decompression, sometimes of several segments. However, there is a lack of adequate instrumentation systems. In the early days of endoscopic thoracolumbar fracture treatment, the established standard intervention was performed after dorsal intervention and reduction and secondary mono-or bisegmental ventral strut grafting with overbridging by four-point stabilization with the Z-plate. However, the Z-plate normally is intended for an open implantation technique. Only time-consuming improvisation, such as screw fixation with strings to prevent loosening, make it applicable in these cases [1,4,19]. McAfee, Regan and Bühren concluded that the limiting factor in the wide application of the endoscopic technique is the absence of a commercially available internal fixation system for this endoscopic approach [4,17,21].The purpose of this study was to prospectively evaluate the feasibility, safety and efficacy of a newly developed anterior stabilization system that allows a complete Abstract A new instrumentation system for ventral stabilization of the spine that can be used for an endoscopic and minimally invasive approach was developed. We describe the implantation technique and report on the first clinical results. This prospective study covers the first 45 patients to undergo this new technique since it was introduced in 1999. In all patients the operation was successfully performed in a completely minimally invasive procedure. Mono-and bisegmental stabilization was performed mainly at the thoracolumbar junction after initial posterior instrumentation in most cases. Lesions varied from fresh/old fractures to metastases (T5-L3). Preand postoperative follow-up included clinical examination and radiological visualization via X-ray and computed tomographic scan. Our experience with this minimally invasive procedure demonstrated the feasibility of the method.

Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease

“…In contrast, the MACS TL system was designed specifically for endoscopic procedures and has been shown to have excellent primary stability when compared with clinically well-established systems for thoracolumbar fractures. 3,37 For interbody reconstruction, we prefer the use of expandable cages over polymethylmethacrylate because their ability to expand, collapse, and be repositioned allows a tighter fit. Furthermore, expandable cages can be used for interbody distraction if there is a kyphotic deformity associated with the pathological fracture.…”

“…Our initial clinical and operative results appear at least comparable with the results of open procedures and other thoracoscopic studies in patients with metastatic spine disease. 15,34,37 A proper comparative evaluation with larger series of patients will be required to definitively compare the results of minimally invasive endoscopic spine surgery with open procedures in patients with tumors.…”

“…Recently, minimally invasive thoracoscopic approaches have been developed for the surgical treatment of thoracic disc herniations and traumatic fractures to overcome the problems associated with thoracotomy. 1,3,4,10,18,29,30,37 We here describe the application of a minimally invasive procedure for the surgical treatment of metastatic spinal cord compression and pathological fractures in the thoracolumbar spine, with an emphasis on recently developed reconstruction and stabilization techniques. Object.…”

Solvent-preserved, bovine cancellous bone blocks used for reconstruction of thoracolumbar fractures in minimally invasive spinal surgery?first clinical results

“…Minimally invasive techniques are becoming more widespread, especially in anterior spinal surgery, due to improved technologies [3,4,5,14,16,22,24,25,29]. Stabilization plays an important role in spinal fracture treatment.…”

“…Stabilization plays an important role in spinal fracture treatment. Sophisticated systems like the Z-plate or the MACS TL system have been developed for endoscopic application [3,16,22,24,29]. Because of these improvements monosegmental fusion has become an alternative in the minimally invasive treatment of A 3.1 fractures [3,4,5,16,24,29].…”