Thoracoscopic Management of Spinal Trauma

Abstract

Dorsal stabilization techniques based on the fixateur interne principle are regarded as the primary treatment method for unstable spinal injuries. For certain types of fracture associated with extensive destruction or defects of the vertebral body and the intervertebral discs, reconstruction of the load-bearing anterior spine is required to avoid loss of correction. Further development of endoscopic technique and standardization of the operating procedure have now made it possible to perform the operation on the ventral section of the spine using minimally invasive thoracoscopy. The operation involves removal of the ruptured intervertebral discs and vertebral fragments including, when necessary, decompression of the spinal canal. The load-bearing capacity of the anterior spine is restored using a vertebral body replacement and ventral instrumentation. The extended thoracoscopic approach described here also opens the retroperitoneal segment between Th12 and L3 to the endoscopic procedure via partial detachment of the diaphragm. Thus, it includes the thoracolumbar section of the lumbar spine, which is the area most frequently affected by fractures.