Three-dimensional thoracoscopic vertebral body replacement at the thoracolumbar junction.

Abstract

The aim is to stabilize the thoracolumbar spine with athoracoscopically implanted vertebral body replacement (VBR). To improve intraoperative depth perception and orientation, implantation is performed under three-dimensional (3D) thoracoscopic vision. Vertebral burst fractures at the thoracolumbar junction (A4AOSpine classification), pseudarthrosis, and posttraumatic instability with increasing kyphosis. Severe pulmonary dysfunctions, pulmonary or thoracic infections, previous thoracic surgery, and pulmonary adhesions. The patient is lying in aright lateral decubitus position. Localization of the fractured vertebra. Minimally invasive transthoracic approach. Perform single lung ventilation and insert the 3D thoracoscope two intercostal spaces above the working portal. Utilization of special binocular glasses for 3D vision of the operation field and secure resection of the fractured vertebra. Measurement of the bony defect and insertion of the expandable cage. Control of correct cage position under fluoroscopy. Insertion of achest tube and inflate the left lung. Chest × ray Remove chest tube when output is <500 ml/24 h Early mobilization on the ward 6weeks no weight-bearing >5 kg RESULTS: Between 2012 and 2017, 12patients received aVBR under 3D thoracoscopic vision. After amean follow up of 26months, no cage dislocation was noticed and all patients recovered from the initial back pain. Complications were notable in two cases (17%) with asmall pneumothorax after removal of the chest tube and postoperative pneumonia in one patient (8%). All responded to conservative treatment. Revision surgery was not necessary.