Management of burst thoracic and thoracolumbar fractures with thoracoscopically assisted anterior corpectomy and posterior short segment percutaneous stabilization

Abstract

Study designThis was a prospective observational study.ObjectiveThe aim of this study was to evaluate the role of thoracoscopically assisted corpectomy of burst thoracic and thoracolumbar fractures combined with posterior percutaneous transpedicular instrumentation.Summary of background dataBecause of the associated morbidities related to the combined open anterior and posterior approaches to thoracic and thoracolumbar spine, some surgeons prefer either the anterior-only or the posterior-only approach that is sometimes not sufficient to achieve the goals of surgery. The combination of two minimally invasive techniques enables the achievement of treatment goals and minimizes the associated morbidities.Patients and methodsBetween January 2008 and December 2008, 26 patients with acute burst spinal fractures were operated upon in our hospital. These patients underwent posterior percutaneous stabilization plus anterior thoracoscopically assisted corpectomy and fusion in the prone position. Clinical and radiological outcomes were evaluated after a minimum follow-up period of 2 years. The Oswestry Disability Index combined with clinical examination was used for clinical evaluation. Plain radiography in two views was used for the radiological evaluation.ResultsThe mean operative time was 240 min. The average blood loss was 745 ml. Ten patients had preoperative neurological deficits ranging from Frankel A to Frankel D. One patient did not show any neurological improvement at the final follow-up. The mean Oswestry Disability Index at the final follow-up was about 7. The mean preoperative kyphosis angle was 26.2°, and improved to 9.2° postoperatively and to 14° at the final follow-up. One patient had a superficial wound-healing problem.ConclusionThoracoscopic decompression and fusion plus short segment posterior percutaneous instrumentation showed good clinical outcomes and can be considered as an alternative to open procedures, with decreased rates of morbidities in the management of burst thoracic and thoracolumbar fractures.