title: 360-degree osteosynthesis via a posterolateral transpedicular approach in high-risk patients.
abstract: OBJECTIVE
  Patients requiring anterior-posterior thoracic spine stabilization and suffering from concomitant cardiopulmonary disease are at increased risk to develop procedure-related complications. In order to reduce cardiopulmonary complications, the efficacy of a posterolateral transpedicular approach for 360-degree fusion was investigated.
  
  
  METHODS
  Fourteen consecutive patients presenting with spinal cord compression from osteoporotic, metastatic and tuberculotic fractures were treated. Spinal cord decompression was achieved by laminectomy, facetectomy and corpectomy with subsequent posterior instrumented fusion using a screw-rod system.
  
  
  RESULTS
  The procedure was successfully performed in 14 high-risk patients. Preoperatively, all patients presented with thoracic and lower back pain and nine patients with a paraparesis (Frankel grade C). The implants were introduced monoportally or biportally. In all cases, neurological symptoms moderately improved.
  
  
  CONCLUSIONS
  The posterolateral transpedicular approach might be a safe, less-invasive and efficient alternative to anterior-posterior fusion. However, biomechanic efficacy and long-term outcome as compared to the transthoracic technique remains to be studied in a larger patient cohort.
authors.affiliation: Department of Neurosurgery, Heinrich-Heine-University, Moorenstraße 5, Düsseldorf, Germany. eicker.s@mac.com
authors.forename: Sven O
authors.initials: SO
authors.lastname: Eicker
authors.forename: Jan Frederik
authors.initials: JF
authors.lastname: Cornelius
authors.forename: Hans-Jakob
authors.initials: HJ
authors.lastname: Steiger
authors.forename: Daniel
authors.initials: D
authors.lastname: Hänggi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013117:Spinal Cord Compression / Q000601:surgery*; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods