title: Video-assisted treatment of thoracolumbar junction fractures using a specific distractor for reduction: prospective study of 50 cases.
abstract: Posterior instrumentation allows good osteosynthesis for thoracolumbar junction fractures. However, in approximately 20% of cases, anterior bone defects may persist, leading to pseudoarthrosis and loss of reduction. Anterior approaches can circumvent this drawback, but they are considered aggressive with a high rate of complications. The advent of the endoscopic mini-invasive techniques has led to a reduction in the number of complications while maintaining the same consolidation rate. Nevertheless, poor restitution of anatomic curves is a reproach for this technique. This prospective study reports clinical and radiological result of 50 patients (19 women and 31 men) operated between April 2000 and March 2006 with a video-assisted anterior approach using an endodistractor for reduction and consequent insertion of the implant. There were A3 (n = 44), A2 (n = 2), A1 (n = 3) and C1 (n = 1) fractures (Magerl classification). The specific system for fracture reduction was used in the last 39 cases of this series. A Pyramesh cage (Medtronic, Memphis, USA) was used in 15 patients, a peek cage (Creaspine, Bordeaux, France) in 30 patients and a tricortical graft in 5 patients. Standard X-rays and CT scan were performed pre-operatively. Kyphosis, and angulations were measured pre-, per- and post-operatively. Mean immediate postoperative gain in localized kyphosis was 12.18 degrees and mean gain at last follow-up was 11.71 degrees. Mean immediate postoperative gain in RA was 13.24 degrees and remained identical at last follow-up. Five patients had a transient pulmonary atelectasia and there was one pulmonary infection. No neurological complication occurred. Fracture reduction is comparable to the best thoracotomy series while limiting approach-related complications.
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery, CHU Bordeaux, 33076, Bordeaux Cedex, France. j-c.lehuec@u-bordeaux2.fr
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Le Huec
authors.forename: C
authors.initials: C
authors.lastname: Tournier
authors.forename: S
authors.initials: S
authors.lastname: Aunoble
authors.forename: K
authors.initials: K
authors.lastname: Madi
authors.forename: Ph
authors.initials: P
authors.lastname: Leijssen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D008159:Lumbar Vertebrae / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D016103:Spinal Fractures / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D013904:Thoracic Vertebrae / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D014143:Traction / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult
references.citation: Orthopedics. 1995 Jul;18(7):673-8
references.pmid: 7479407
references.citation: Injury. 2000 Jun;31(5):333-6
references.pmid: 10775687
references.citation: Neurosurgery. 2002 Nov;51(5 Suppl):S104-17
references.pmid: 12234437
references.citation: J Orthop Trauma. 2001 Nov;15(8):566-9
references.pmid: 11733673
references.citation: Arch Orthop Trauma Surg. 1998;117(1-2):92-5
references.pmid: 9457348
references.citation: Acta Neurochir (Wien). 1991;109(1-2):12-9
references.pmid: 2068961
references.citation: Spine (Phila Pa 1976). 1998 Jun 15;23(12):1333-40
references.pmid: 9654622
references.citation: Surg Endosc. 1999 Apr;13(4):346-50
references.pmid: 10094745
references.citation: J Neurosurg. 1996 Apr;84(4):565-72
references.pmid: 8613847
references.citation: Eur Spine J. 1994;3(4):184-201
references.pmid: 7866834
references.citation: Spine (Phila Pa 1976). 1982 Jul-Aug;7(4):335-42
references.pmid: 7135066
references.citation: Eur Spine J. 2002 Jun;11(3):251-7
references.pmid: 12107794
references.citation: Spine (Phila Pa 1976). 1998 Nov 15;23(22):2427-31
references.pmid: 9836357
references.citation: Orthopade. 2002 Apr;31(4):413-22
references.pmid: 12056285
references.citation: Injury. 2002 May;33(4):357-65
references.pmid: 12091034
references.citation: Clin Orthop Relat Res. 2003 Jun;(411):25-31
references.pmid: 12782856
references.citation: Unfallchirurg. 2002 Oct;105(10):873-80
references.pmid: 12376893
references.citation: Eur Spine J. 1996;5(2):112-20
references.pmid: 8724191
references.citation: Spine (Phila Pa 1976). 1995 Jul 15;20(14):1624-32
references.pmid: 7570179
references.citation: Spine (Phila Pa 1976). 1994 May 1;19(9):1087-91
references.pmid: 8029748
references.citation: Spine (Phila Pa 1976). 1982 Jul-Aug;7(4):365-73
references.pmid: 7135069
references.citation: Spine (Phila Pa 1976). 1995 Apr 1;20(7):831-7
references.pmid: 7701398
references.citation: Spine (Phila Pa 1976). 2000 Apr 1;25(7):876-83
references.pmid: 10751301
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 1997;83(3):203-9
references.pmid: 9255355
references.citation: Spine (Phila Pa 1976). 1995 Jul 15;20(14):1592-9
references.pmid: 7570174
references.citation: Spine (Phila Pa 1976). 1991 Mar;16(3 Suppl):S100-11
references.pmid: 2028324
references.citation: Paraplegia. 1969 Nov;7(3):179-92
references.pmid: 5360915
references.citation: Surg Endosc. 1999 Dec;13(12):1215-9
references.pmid: 10594269
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 1989;75(8):558-68
references.pmid: 2636442
references.citation: J Am Acad Orthop Surg. 2003 Sep-Oct;11(5):355-63
references.pmid: 14565757
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 1988;74 Suppl 2:296-8
references.pmid: 3231804
references.citation: Eur Spine J. 2004 Mar;13(2):101-7
references.pmid: 14615927
references.citation: Burns. 1993 Apr;19(2):134-7
references.pmid: 8471147
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 2001 Feb 1;87(1):73-8
references.pmid: 11240540
references.citation: Neurosurgery. 2002 Nov;51(5 Suppl):S88-95
references.pmid: 12234435