Abord mini-invasif de la charnière thoracolombaire du rachis par voie extrapleurale, rétropéritonéale. Étude prospective sur 40 cas

Abstract

Study designProspective study. Background and purposeThe anterior spinal cord decompression and spinal interbody fusion is considered an effective therapeutic procedure for thoracolumbar spine junction (TLSJ) (T11 to L2) fractures and tumors. However, it is also known to be associated with considerable surgery-related trauma. The purpose of this study was to show that neural elements decompression and anterior reconstruction at the TLSJ can be performed via a minimally invasive extrapleural retroperitonal approach (MIERA). MethodsThe authors studied prospectively the hospital records and radiological data obtained in 40 patients (mean age: 43.6 years, range: 16–74 years) who all underwent first a posterior fixation followed by a thoracic (T11 or T12) or lumbar (L1 or L2) corpectomy and spinal fusion via a MIERA. ResultsThe MIERA provided excellent exposure to facilitate complete decompression and anterior reconstruction in all patients, as verified on follow-up radiographic studies. More than 2years follow-up record is available for 24 patients, a one year follow-up record for 14 others, and six months follow-up for the last two ones. Radiography demonstrated anatomically correct reconstruction in all patients, as well as a solid fusion or a stable compound union in the 24patients for whom a minimum of 2years follow-up records was available. ConclusionsThe MIERA allows the surgeon to perform anterior thoracolumbar spine surgery via a less invasive approach. The authors demonstrate the efficacy and safety of this technique and its potential to reduce perioperative morbidity compared with conventional retroperitoneal lumbar spine surgery or thoracophrenolombotomy.