Abstract
PurposeTo determine the health-related quality of life (QOL), safety and radiologic parameters after thoracoscopic treatment of traumatic thoracolumbar fractures using a distractible cage in patients without spinal cord injury (SCI).MethodsRetrospective cohort study of patients treated between 2004 and 2012 in a university level-one trauma center. Patient and treatment characteristics were collected from the hospital information system. All available radiographic material was assessed for fracture characteristics and Cobb angle at consecutive times. Patients completed the SF-36 and EQ-5D QOL questionnaires at follow-up.Results105 patients were treated with a distractible cage, which was performed thoracoscopically in 86 cases, including 16 patients with SCI. Of 70 eligible patients, 46 were available for follow-up and completed the questionnaires at median 49 months after surgery. QOL was lower on most domains compared to the general population. Compared to patients who underwent solely posterior fixation for less severe fractures, QOL did not differ significantly. The complication rate was low (10%) with one re-operation. Mean loss of correction was 6.8° and bony fusion on CT scan was present in 98% of patients. Maintenance of kyphosis correction was significantly better for two segments anterior fixation compared to one segment.ConclusionsThoracoscopic anterior stabilization leads to a high percentage of bony fusion in highly unstable thoracic and thoracolumbar fractures with limited post-operative loss of correction and no hardware failure. QOL of these patients does not return to normal population values but is comparable to that of patients with less severe fractures treated with solely posterior instrumentation.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Materials and methodsA growing number of spine surgeons advocate the reconstruction of the anterior spinal column in cases with insufficient anterior load bearing capacity [1,2,3,4,5,6,7]
Thoracoscopic anterior stabilization with a distractible cage leads to a high percentage of bony fusion and a stable construction in unstable thoracic and thoracolumbar fractures
Health related quality of life does not return to population values but is comparable to that of patients with less severe fractures treated with solely posterior instrumentation
Summary
Materials and methodsA growing number of spine surgeons advocate the reconstruction of the anterior spinal column in cases with insufficient anterior load bearing capacity [1,2,3,4,5,6,7]. Additional anterior stabilization provides stability to the anterior column, thereby preventing loss of correction and posterior implant failure [7, 8]. With the use of titanium cages, the disadvantages of autologous bone struts are prevented such as operating time, donor site morbidity, non-union and fracture of the strut graft [9]. Satisfactory results were obtained, the minimally invasive video-assisted thoracoscopy (VATS) technique provides advantages such as smaller incisions, no need for rib resection, excellent visualization and minimal surgical chest wall injury [13]. If stabilization with a cage is performed using VATS, a stable construction can be provided through a minimally invasive procedure to reduce surgical damage [13,14,15,16,17]
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