Revision surgery for posterior stabilized thoracolumbar fracture using mini-open anterior approach and expandable cage.
OBJECTIVE
To evaluate the surgical techniques and outcomes of revision surgery for compromised posterior stabilization or insufficient neurological decompression using anterior mini-open approach and expandable cage.


METHODS
From August 2005 to June 2008, a total of 235 patients were operated on in our center for thoracolumbar fractures with dorsal transpedicular stabilization. Twenty-six of these patients underwent revision surgery, the main reasons being back pain and stagnant neurological recovery. The surgical procedure comprised a single-level thoracolumbar corpectomy and/or canal clearance, followed by an expandable cage reconstruction. The average interval between primary and revision surgery was 5 months (range, 3-11 months). A transthoracic (n= 11) or transthoracic transdiaphragmatic (n= 15) mini-open approach was conducted using a table-mounted retractor.


RESULTS
The operating time averaged 105 min (range, 95-135 min) for the transthoracic approach and 152 min (range, 120-190 min) for the transthoracic plus transdiaphragmatic approach. The overall mean blood loss was 780 ml (range, 550-1700 ml). Over time, the pre-operative neurological deficit improved in 6/7 patients by at least one Frankel/American Spinal Injury Association (ASIA) grade. On a visual analogue scale (VAS) from 0 to 10, the mean local thoracolumbar back pain was relieved significantly from 6.8 before operation to 3.8 at 3 months, 2.4 at 6 months, and 1.5 at 12 months postoperatively. None of the patients developed intercostal neuralgia or post-thoracotomy pain syndromes.


CONCLUSIONS
For patients with compromised stabilization or insufficient neurological decompression after primary dorsal transpedicular stabilization for thoracolumbar fracture, anterior revision surgery can produce good results. The mini-open anterior approach for corpectomy in the thoracolumbar spine is safe, reliable, and economical. The expandable cage is an excellent alternative for anterior reconstruction.
Spinal Center, Affiliated Hospital of Nantong University, Nantong, China. drzhaojian@vip.sina.com
Jian
J
Zhao
Klaus-Dieter
KD
Schaser
Feng
F
Zhang
D000328:Adult; D001416:Back Pain / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D024162:Second-Look Surgery / Q000295:instrumentation / Q000379:methods; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult