Abstract
Purpose: The purpose of this study was to analyse the results and morbidity of video-assisted minimally invasive thoracoctomy for anterior arthrodesis of thoracolumbar fractures treated with a two-stage procedure and to evaluate mid-term outcome.
Material and methods: This retrospective series included 6 patients with an unstable thoracolumbar fracture who underwent surgery between November 1997 and June 2002. A two-stage procedure was used: posterior reduction osteosynthesis and anterior arthrodesis with a tricortico-cancellous graft via video-assisted minimally invasive thoracotomy. The cohort included six women and eighteen men, mean age 34.5 years. Fractures were located at: L1 (n=4), T12 (n=10), T11 (n=2). At initial assessment the Franckel classification was: A (n=3), B (n=1), C (n=1), D (n=3), 3 (n=18). Time between the posterior procedure and the anterior thoracotomy was 30.2 days (range 6–86). Postoperative results as well as the time to fusion were recorded. Mean follow-up was 21 months (range 6–45) for functional and radiological assessment. No patient was lost to follow-up.
Results: Mean operative time was 188 min (range 80–240). Mean blood loss was 235 ml (range150–1000) with no intraoperative event requiring conversion to open thoracotomy. Mean duration of morphine administered postoperatively was 2.2 days, the same as for thoracic drainage. Residual pleural effusion was observed in one patient and residual pneumothorax in two; all resolved spontaneously. Mean hospital stay was 12 days (range 6–27). Twenty-five patients had achieved fusion at four months. One patient developed a radiological non-union which was asymptomatic at one year. At last follow-up, the Oswestry function score was 22.6% for the entire series, 18% for Franckel D or E patients (n=21) and 42% for Franckel A, B and C patients (n=5). Loss of angular correction of the spinal kyphosis and regional traumatic angulation between the postoperative films and the last follow-up films was 2 (mean).
Discussion: This series of complementary anterior arthrodesis by video-assisted minimally invasive thoracotomy confirmed the minimally invasive nature of this approach in comparison with thoracophrenolaparotomy and its complications. At mid term, this technique has provided satisfactory functional and radiographic results. Applied for thoracolumbar fractures, this combined surgical option can limit intraoperative morbidity and assure good mid-term results.
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