1:42 Thorascopic transdiaphragmatic decompression and stabilization of thoracolumbar fractures: 220 cases from two institutions

Abstract

Purpose of study: Conventional thoracoabdominal surgical approach for thoracolumbar junction fractures requires extensive exposures and diaphragm splitting, which can cause significant associated morbidity. With recent developments in endoscopic instruments (MACS-tl, Aesculap) and technique, minimally invasive stabilization of thoracolumbar junction fractures (T11–L2) using thoracoscopic approach has developed.Methods used: Over past 5 years (1996–2001), 420 patients were managed with thoracoscopic-assisted stabilization with or without decompression. Of those patients with thoracolumbar junction fractures, 220 required thoracoscopic diaphragm detachment to achieve access for decompression and instrumentation. Restrospective analysis was done with clinical chart and radiologic studies of thoracoscopic-assisted stabilization. Clinical presentation, operative detail, complications and postoperative course were analyzed.of findings: Most were type A injury (61%) according to AO classification. Average operative time was 172 minutes for thoracoscopic anterior operation. Sixty-five percent of patients required combined posterior stabilization. Average hospitalization was less than 1 week after operation. Access-related complications occurred in 5.4%, and infection was noted 1.8%. No hernia or relaxation of the diaphragm has been recorded. One transient injury of the L1 root occurred during thoracoscopic detachment of the diaphragm. Partial loosening of implant occurred in two patients with severe osteoporosis. One case was converted to open procedure.Relationship between findings and existing knowledge: Although thoracoscopic management of thoracolumbar fractures with diaphragm detachment is a relatively newer technique and a demanding procedure, earlier functional recovery and postoperative pain reduction can be achieved when compared with open thoracoabdominal approach.Overall significance of findings: This study demonstrates that the thoracolumbar junction fractures can be treated successfully using thoracoscopic technique with diaphragm detachment.Disclosures: Device or drug: MACS-tl. Status: approved.Conflict of interest: No conflict.