Three-dimensional thoracoscopic vertebral body replacement at the thoracolumbar junction.
Oper Orthop Traumatol
; 30(5): 369-378, 2018 Oct.
Article
in En
| MEDLINE
| ID: mdl-30076428
ABSTRACT
OBJECTIVE:
The aim is to stabilize the thoracolumbar spine with a thoracoscopically implanted vertebral body replacement (VBR). To improve intraoperative depth perception and orientation, implantation is performed under three-dimensional (3D) thoracoscopic vision. INDICATIONS Vertebral burst fractures at the thoracolumbar junction (A4 AOSpine classification), pseudarthrosis, and posttraumatic instability with increasing kyphosis. CONTRAINDICATIONS Severe pulmonary dysfunctions, pulmonary or thoracic infections, previous thoracic surgery, and pulmonary adhesions. SURGICAL TECHNIQUE The patient is lying in a right 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 a chest tube and inflate the left lung. POSTOPERATIVE MANAGEMENT Chestâ¯× ray Remove chest tube when output is <500â¯ml/24â¯h Early mobilization on the ward 6 weeks no weight-bearing >5â¯kgRESULTS:
Between 2012 and 2017, 12 patients received a VBR under 3D thoracoscopic vision. After a mean follow up of 26 months, no cage dislocation was noticed and all patients recovered from the initial back pain. Complications were notable in two cases (17%) with a small pneumothorax after removal of the chest tube and postoperative pneumonia in one patient (8%). All responded to conservative treatment. Revision surgery was not necessary.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Thoracic Vertebrae
/
Thoracoscopy
/
Spinal Fractures
/
Fractures, Compression
/
Lumbar Vertebrae
Type of study:
Etiology_studies
Limits:
Female
/
Humans
/
Male
/
Newborn
Language:
En
Journal:
Oper Orthop Traumatol
Journal subject:
ORTOPEDIA
/
TRAUMATOLOGIA
Year:
2018
Document type:
Article
Affiliation country:
Germany