Technique and clinical results of minimally invasive reconstruction and stabilization of the thoracic and thoracolumbar spine with expandable cages and ventrolateral plate fixation.
OBJECTIVE
To evaluate the techniques of minimally invasive single- and multilevel corpectomy and reconstruction of the thoracic and thoracolumbar spine using expandable vertebral body replacement (VBR) cages and ventrolateral plate fixation (VPF) via anterolateral retropleural (ALRA) and combined thoracoabdominal approaches.


METHODS
38 patients with spondylitis, traumatic or metastatic lesions of thoracic or thoracolumbar vertebrae T4 to L2 underwent spinal decompression and ventral column reconstruction with correction of spinal deformity by VBR and VPF via ALRA or a combined lateral extrapleural/extraperitoneal (extracoelomic) thoracolumbar approach (CLETA). Overall clinical and neurological outcome, operative time, blood loss, reduction of deformity, and postoperative pain were assessed during a mean follow-up period of 22.8 months.


RESULTS
VBR and VPF were carried out successfully without conversion to conventional approaches in all patients. Mean operative time (ALRA, 163 +/- 33 min; CLETA, 175 +/- 39 min), mean blood loss (ALRA, 280 +/- 160 ml; CLETA, 420 +/- 250 ml), average correction (19.3 degrees), loss of correction of sagittal deformity (0.9 degrees), and clinical outcome compare favorably to the results reported for open and endoscopic techniques. Postoperative pain levels (mean visual analog scale score at 24 h, 2.7 +/- 0.9) and the incidence of postoperative pulmonary dysfunction (three out of 38 patients) were low. The average length of stay was 7.4 days. ALRA and CLETA obviate routine chest tube insertion, thus allowing for early postoperative ambulation (average, 1.1 d).


CONCLUSIONS
Minimally invasive VBR and VPF conducted via minimally invasive approaches (ALRA or CLETA) yields favorable clinical results at least equal to conventional open surgery, with significant reductions in perioperative morbidity and pain, expedited ambulation, and early discharge from the hospital.
Scheufler
Kai-Michael
KM
Department of Neurosurgery, NeuroCenter Zurich, Klinik Hirslanden, Zurich, Switzerland. Kai.Scheufler@hirslanden.ch
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000000981:diagnostic imaging / Q000601:surgery; D001860:Bone Plates; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D019736:Prostheses and Implants; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*