Minimally invasive spine surgery for thoracolumbar vertebral fracture using a movable window method

Abstract

Objective To investigate the efficacy of surgery for thoracolumbar vertebral fracture using a movable window method. Methods From September 2009 through September 2014, 24 patients with thoracolumbar vertebral fracture were treated at our department. They were 14 men and 10 women, with an average age of 31.2 years (range, 20 to 45 years). All the patients suffered from fracture of single segment, involving T8 in one, T10 in one, T11 in 3, T12 in 10, L1 in 8, and L2 in one. All the patients were treated with pedicle screw fixation through the multifidus and longissimus approach (the Wiltse approach) using a movable incision window method. Preoperatively, the movable distance between cranial and caudal skin was measured. The anteroposterior and lateral X-ray films were taken for radiological evaluation at follow-ups. Clinical outcomes were also evaluated pre- and postoperatively using visual analog scale (VAS) and Oswestry disability index (ODI). Results The movable distance of skin: craniad: 1.3 cm to 6.0 cm (mean, 3.0±0.9 cm); caudad: 0.9 cm to 2.0 cm (mean, 1.7±0.7 cm); total longitudinal move: 4.0 cm to 6.2 cm (mean, 4.8±0.4 cm). The 5 cm incision, through which internal fixation was performed, was positioned between the lower margin of the index spinal process and the lower margin of the cranial spinal process. The follow-ups ranged from 8 to 18 months. The radiological findings at the last follow-up revealed satisfying fracture reduction without loosening or breakage of the instrumentation. The VAS and ODI were significantly improved after surgery. Conclusion The movable window method, based on the human skin mobility, can be used to facilitate the thoracolumbar vertebral surgery via the multifidus and longissimus approach. Key words: Thoracic vertebrae; Lumber vertebrae; Fractures, bone; Surgical procedures, minimally invasive