Thoracoscopically Assisted Vertebral Reconstruction Simultaneously with Percutaneous Pedicle Screws Fixation for Management of Thoracic and Thoracolumbar Spinal Fractures.

Abstract

Background Data: Thoracic and thoracolumbar fractures are commonly provoked by axial compression which disrupts the anterior column. In this setting, posterior stabilization using pedicle screws alone may lead to delayed kyphosis and hardware failure due to inadequate anterior column support. Application of thoracoscopic anterior column reconstruction while patient in prone position for posterior percutaneous instrumentation is a minimally invasive combined technique.Purpose: To evaluate the outcome of percutaneous pedicle screw instrumentation in combination with thoracoscopically assisted vertebral reconstruction using expandable titanium cage.Study Design: Prospective clinical case study.Patients and Methods: Eighteen patients with acute thoracolumbar fractures with different preoperative neurological status were recruited for this study. Patients were treated using a short segment percutaneous screw fixation construct combined with thoracoscopic corpectomy and insertion of expandable cage. Patients were followed for at least 6 months. Visual analogue scale (VAS), Oswestry disability index (ODI) and local kyphotic angle were recorded prospectively and compared to preoperative parameters. Intraoperative data including operative time, blood loss and perioperative complication was documented.Results: Patients were operated within 7 days after trauma using combined anterior and posterior stabilization technique. Mean operative time was 213±42 min (Range, 170-300). The mean blood loss was 225±79 ml (Range, 100-350). The mean VAS score improved significantly after surgery. The mean of ODI preoperatively was 74±6.9 preoperatively and improved after 6 months to become 17.5±14.6. The mean regional kyphotic angle was 22.6±6.82ᴼ preoperatively,  improved to 6.9±4.1ᴼ postoperatively and at final follow-up it became 8.67±4.8ᴼ. No patient had neurological deterioration or hardware failure during ≥6 months of follow up.Conclusion: our data suggest that thoracoscopic anterior reconstruction and decompression augmented with posterior percutaneous in prone position yield good clinical and radiological results with minimal complications in thoracolumbar trauma. (2018ESJ158)