[Combined posterior and anterior endoscopic supported instrumentation of the thoracic and lumbar spine. Arguments, concepts and first clinical results].
The operative therapeutic principles of thoracic and lumbar spine injuries are based on reposition, decompression and stabilization of the unstable area. Secondary loss of correction and consecutive deformation have negative impact on the long-term results after defect fractures of vertebral bodies and will be minimized only by the reconstruction of all involved spinal columns. With dissemination of thoracoscopic techniques at the thoracic spine and minimal invasive retroperitoneal approaches at the lumbar spine a decrease of the morbidity was achieved with equal effectivity for recalibration and fusion. Our experiences with the first consecutive 42 patients, treated minimal invasive are presented. Indications for anterior thoracoscopic and minimal invasive instrumentations after posterior transfixation are remaining osseous defects of the end plates of more than a quarter of the volume of the involved vertebra in case of migration of the vertebral disc, wedging of the vertebral body after posterior reposition of more than 10 degrees and persisting anterior encroachment of the spinal canal of more than 30 %. The decision is based on radiographs and CT-scans, performed after posterior stabilization.
Arand
M
M
Abteilung für Unfallchirurgie, Hand- und Wiederherstellungschirurgie der Universität Ulm, Germany. markus.arand@medizin.uni-ulm.de
Kinzl
L
L
Hartwig
E
E
D016025:Bone Transplantation / Q000295:instrumentation; D019299:Decompression, Surgical / Q000295:instrumentation; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D013525:Surgical Instruments; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery; D013906:Thoracoscopy