J Korean Soc Spine Surg.  2016 Sep;23(3):177-182. 10.4184/jkss.2016.23.3.177.

Video-Assisted Thoracoscopic Minimally Invasive Anterior Interbody Fusion of the T11-T12 Level Using Direct Lateral Interbody Fusion Devices: A Case Report

• Suh SP
• Shim JH
• Shin TY
• Kim JK
• Kang CN

• KMID: 2353909
• DOI: http://doi.org/10.4184/jkss.2016.23.3.177

Abstract

STUDY DESIGN: Case report
OBJECTIVES
To report a case of video-assisted thoracoscopic (VAT) minimally invasive anterior interbody fusion of the T11-T12 level using direct lateral interbody fusion (DLIF) devices. SUMMARY OF LITERATURE REVIEW: Interbody fusion of the thoracolumbar junction (especially T11-T12) is technically challenging from anterior, lateral, or posterior approaches. A VAT anterior interbody fusion approach using DLIF devices is a safe, minimally invasive alternative approach to the thoracolumbar spine.
MATERIALS AND METHODS
A 37-year-old male pedestrian was struck by a car sustaining fracture-dislocation at the T11-T12 level. The accident resulted in complete paraplegia of both lower extremities and multiple lower extremity fractures. A classical instrumented posterolateral fusion from T8 to L3 and staged VAT anterior interbody fusion at the T11-T12 level were performed.
RESULTS
At one year postoperatively, he was capable of independent ambulation using a wheelchair without back pain, and plain radiographs and CT scans showed a solid fusion at the T11-T12 level.
CONCLUSIONS
VAT anterior interbody fusion using DLIF devices provides excellent access to the anterior spinal column with the added benefits of an improved field of view and can be a safe and effective alternative to open thoracotomy in the management of various thoracolumbar junction problems.

Keyword

Video-assisted thoracoscopic surgery; Direct lateral interbody fusion; Minimally invasive surgery; Thoracolumbar junction

MeSH Terms

Adult
Back Pain
Humans
Lower Extremity
Male
Minimally Invasive Surgical Procedures
Paraplegia
Spine
Thoracic Surgery, Video-Assisted
Thoracotomy
Tomography, X-Ray Computed
Walking
Wheelchairs

Figure

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  Fig. 1. The plain radiographs of 37-year-old male pedestrian, who was struck by a car, show fracture-dislocation injury at the T11-T12 level (A, B). The accident resulted in complete paraplegia of both lower extremities.

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  Fig. 2. Sagittal (A), coronal (B), and axial (C) computed tomography scans and magnetic resonance imaging (D) show fracture-dislocation injury at the T11-T12 level. A transection cord injury at the T11 body level, lateral displacement with intervertebral subluxation, and fracture at both superior articular processes of the T12 vertebra occurred.

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  Fig. 3. Lateral radiographs of the surgical site preoperatively (A) and after posterior operation (B) are shown. After the posterior operation, the T11-T12 interbody space was widened from 5 mm to 12 mm and facet joint subluxation still existed.

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  Fig. 4. A thoracoscopic image shows the T11-T12 level (A). The dia-phragm (asterisk) was detached from the chest wall to expose the T11-T12 interbody disc space. A guide pin was inserted at the T11-T12 interbody disc space. An intraoperative image is shown (B). Serial dila-tors were inserted directly lateral to the T11-T12 interbody disc space. A viewing camera and instruments for thoracoscopy were inserted via trocars.

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  Fig. 5. Postoperative anteroposterior (A) and lateral (B) plain radiographs show T8-L3 transpedicular fixation, T11-T12 interbody fusion, and posterolateral fusion. The postoperative 1 year coronal (C) and sagittal (D) CT scans show a solid bony union at the interbody space.

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