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

Abstract

Purpose To determine the health-related quality of life (QOL), safety and radiologic parameters after thoracoscopic treatment of traumatic thoracolumbar fractures using a distractible cage in patients without spinal cord injury (SCI). Methods Retrospective cohort study of patients treated between 2004 and 2012 in a university level-one trauma center. Patient and treatment characteristics were collected from the hospital information system. All available radiographic material was assessed for fracture characteristics and Cobb angle at consecutive times. Patients completed the SF-36 and EQ-5D QOL questionnaires at follow-up. Results 105 patients were treated with a distractible cage, which was performed thoracoscopically in 86 cases, including 16 patients with SCI. Of 70 eligible patients, 46 were available for follow-up and completed the questionnaires at median 49 months after surgery. QOL was lower on most domains compared to the general population. Compared to patients who underwent solely posterior fixation for less severe fractures, QOL did not differ significantly. The complication rate was low (10%) with one re-operation. Mean loss of correction was 6.8° and bony fusion on CT scan was present in 98% of patients. Maintenance of kyphosis correction was significantly better for two segments anterior fixation compared to one segment. Conclusions Thoracoscopic anterior stabilization leads to a high percentage of bony fusion in highly unstable thoracic and thoracolumbar fractures with limited post-operative loss of correction and no hardware failure. QOL of these patients does not return to normal population values but is comparable to that of patients with less severe fractures treated with solely posterior instrumentation. Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Key pointsThoracoscopy, anterior stabilization, titanium cage, thoracic and lumbar fractures, quality of life, kyphosis 1. Traumatic thoracic and lumbar fractures with an insufficient anterior load bearing capacity can be treated with a titanium cage through a minimally invasive thoracoscopic approach.2. Quality of life was compared to a group of patients that underwent solely posterior fixation for (less severe) traumatic fractures.3. Additionally, safety and radiologic parameters were assessed.

Traumatic Fractures of the Thoracic Spine

“…The main disadvantages of the open approach are the relatively high complication rates and post-thoracotomy pain syndrome, which can develop in up to 31 % of cases [57,58]. In many hospitals over recent years, minimally invasive thoracoscopic stabilisation has therefore established itself and significantly reduced access morbidity [59]. Alternatively, anterior stabilisation, e.g.…”

“…In den letzten Jahren hat sich dementsprechend in vielen Kliniken die minimalinvasive bzw. thorakoskopische Stabilisation durchgesetzt, welche die Zugangsmorbidität deutlich verringert [59]. Alternativ kann die ventrale Stabilisation z.…”

Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study

“…Recently, Smits et al [10] reported promising results in 46 patients with thoracolumbar fractures treated by MIAS at a median follow-up of 49 months. Thereby, the overall bisegmental loss of reduction in this cohort was comparable to our results with a mean of 6.8°.…”

“…In 2013, Spiegl et al [9] reported predominantly promising 6-year results and a low complication rate in patients with incomplete thoracolumbar burst fractures. Smits et al [10] published promising long-term results in 46 patients treated by MIAS. Notably, the overall spinal alignment was not evaluated although this is suggested to represent an important prognostic parameter [11] for long-term success of treatment.…”

Innovative Method of Pericardial Fenestration Associated With Underlying Chronic Recurrent Pericarditis: Case Report

“…В последние несколько десятилетий отмечается практически тотальная экспансия методов торакоскопической хирургии при лечении многих заболеваний и травмы органов груди [1,2,3]. При этом эволюция хирургических доступов для проведения торакоскопии движется в направлении от классических -многопортовых -до однопортовых операций и простирается далее в сторону использования нестандартных доступов [4,5].…”