J Korean Neurotraumatol Soc.  2011 Apr;7(1):24-28. 10.13004/jknts.2011.7.1.24.

Clinical and Radiological Analysis of Thoracoscopic Spinal Surgery in Thoracolumbar Burst Fracture

• Jung JR
• Park SB

• KMID: 1427649
• DOI: http://doi.org/10.13004/jknts.2011.7.1.24

Abstract

OBJECTIVE
To evaluate the effectiveness and reasonability of thoracoscopic spinal surgery in patients with thoracolumbar burst fractures.
METHODS
The authors reviewed the patients who had undergone thoracoscopic spine surgery for thoracolumbar burst fracture between January 2008 and October 2010. Spine lateral radiographs were taken at preoperative and follow-up periods and thoracolumbar kyphosis (T11-L2 Cobb angle) was measured. Oswestry disability index (ODI) and Visual analogue scale (VAS) scores were also measured preoperatively and follow-up.
RESULTS
There were three male patients and 2 female patients and a mean age of patients was 51.6+/-14.38 years. Mean follow-up duration was 14.0+/-7.8 months. The mean ODI score in follow-up period was significantly improved (40+/-1.5 and 13+/-11.4, p=0.043). The difference between preoperative and follow-up mean VAS scores was significant (8+/-1.1 and 1+/-1.7, p=0.042). Mean preoperative kyphotic angle was 21.4+/-6.48 degree and mean follow-up kyphotic angle was 10.3+/-7.41 degree. There was significant difference (p=0.036). One patient complained a transient intercostal neuralgia and there was postoperative chylothorax in other patient.
CONCLUSION
In this study, there are good clinical and radiological results after thoracoscopic spine surgery in short-term period. Although thoracoscopic spine surgery requires a steep learning curve, it could be a promising technique with good results in thoracolumbar burst fracture.

Keyword

Thoracoscopy; Thoracolumbar; Spine; Fracture

MeSH Terms

Chylothorax
Female
Follow-Up Studies
Humans
Kyphosis
Learning Curve
Male
Neuralgia
Spine
Thoracoscopy

Figure

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  FIGURE 1 Portal placement. The working portals are located between anterior and middle axillary line and the triangulation should be considered.

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  FIGURE 2 The first screw of MACS TL plate system (Aesculap) is inserted into the caudal vertebral body.

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  FIGURE 3 This picture shows the partial corpectomy site of thoracic vertebra.

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  FIGURE 4 This picture shows the intraoperative view of cage and bone segment insertions.

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  FIGURE 5 Postoperatively anteroposterior (A) and lateral (B) plain films show T12 burst fracture and postoperatively anteroposterior (C) and lateral (D) plain films show partial corpectomy and circumferential fixation at thoracolumbar vertebrae.

Reference

1. Bartels RH, Peul WC. Mini-thoracotomy or thoracoscopic treatment for medially located thoracic herniated disc? Spine (Phila Pa 1976). 2007; 32:E581–E584.

2. Coltharp WH, Arnold JH, Alford WC Jr, Burrus GR, Glassford DM Jr, Lea JW 4th, et al. Videothoracoscopy: improved technique and expanded indications. Ann Thorac Surg. 1922; 53:776–778.

3. Dickman CA, Rosenthal D, Karahalios DG, Paramore CG, Mican CA, Apostolides PJ, et al. Thoracic vertebrectomy and reconstruction using a microsurgical thoracoscopic approach. Neurosurgery. 1996; 38:279–293.

4. Han PP, Kenny K, Dickman CA. Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures. Neurosurgery. 2002; 51:S88–S95.

5. Harrop JS, Vaccaro AR, Hurlbert RJ, Wilsey JT, Baron EM, Shaffrey CI, et al. Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. Invited submission from the Joint Section Meeting On Disorders of the Spine and Peripheral Nerves, March 2005. J Neurosurg Spine. 2006; 4:118–122.

6. Horowitz MB, Moossy JJ, Julian T, Ferson PF, Huneke K. Thoracic discectomy using video assisted thoracoscopy. Spine (Phila Pa 1976). 1994; 19:1082–1086.

7. Huang TJ, Hsu RW, Liu HP, Hsu KY, Liao YS, Shih HN, et al. Video-assisted thoracoscopic treatment of spinal lesions in the thoracolumbar junction. Surg Endosc. 1997; 11:1189–1193.

8. Khoo LT, Beisse R, Potulski M. Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery. 2002; 51:S104–S117.

9. Kim SJ, Sohn MJ, Ryoo JY, Kim YS, Whang CJ. Clinical Analysis of Video-assisted Thoracoscopic Spinal Surgery in the Thoracic or Thoracolumbar Spinal Pathologies. J Korean Neurosurg Soc. 2007; 42:293–299.

10. Landreneau RJ, Mack MJ, Hazelrigg SR, Dowling RD, Acuff TE, Magee MJ, et al. Video-assisted thoracic surgery: basic technical concepts and intercostal approach strategies. Ann Thorac Surg. 1992; 54:800–807.

11. Lewis RJ, Caccavale RJ, Sisler GE. Imaged thoracoscopic surgery: a new thoracic technique for resection of mediastinal cysts. Ann Thorac Surg. 1992; 53:318–320.

12. Longo UG, Papatietro N, Maffulli N, Denaro V. Thoracoscopy for minimally invasive thoracic spine surgery. Orthop Clin North Am. 2009; 40:459–464.

13. Mack MJ, Regan JJ, Bobechko WP, Acuff TE. Application of thoracoscopy for diseases of the spine. Ann Thorac Surg. 1993; 56:736–738.

14. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976). 1994; 19:1741–1744.

15. Niemeyer T, Freeman BJ, Grevitt MP, Webb JK. Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity. Eur Spine J. 2000; 9:499–504.

16. Rosenthal D, Dickman CA. Thoracoscopic microsurgical excision of herniated thoracic discs. J Neurosurg. 1998; 89:224–235.

17. Rosenthal D, Rosenthal R, de Simone A. Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine (Phila Pa 1976). 1994; 19:1087–1091.