Skip to main content
Erschienen in: European Spine Journal 1/2010

01.03.2010 | Original Article

Video-assisted treatment of thoracolumbar junction fractures using a specific distractor for reduction: prospective study of 50 cases

verfasst von: Jean-Charles Le Huec, C. Tournier, S. Aunoble, K. Madi, Ph. Leijssen

Erschienen in: European Spine Journal | Sonderheft 1/2010

Einloggen, um Zugang zu erhalten

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° and mean gain at last follow-up was 11.71°. Mean immediate postoperative gain in RA was 13.24° 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.
Literatur
1.
Zurück zum Zitat Andress HJ, Braun H, Helmberger T, Schurmann M, Hertlein H, Hartl WH (2002) Long-term results after posterior fixation of thoraco-lumbar burst fractures. Injury 33(4):357–365CrossRefPubMed Andress HJ, Braun H, Helmberger T, Schurmann M, Hertlein H, Hartl WH (2002) Long-term results after posterior fixation of thoraco-lumbar burst fractures. Injury 33(4):357–365CrossRefPubMed
2.
Zurück zum Zitat Baulot E, Trouilloud P, Ragois P, Giroux EA, Grammont PM (1997) Anterior spinal fusion by thoracoscopy. A non-traumatic technique. Rev Chir Orthop Reparatrice Appar Mot 83(3):203–209PubMed Baulot E, Trouilloud P, Ragois P, Giroux EA, Grammont PM (1997) Anterior spinal fusion by thoracoscopy. A non-traumatic technique. Rev Chir Orthop Reparatrice Appar Mot 83(3):203–209PubMed
3.
Zurück zum Zitat Been HD, Poolman RW, Ubags LH (2004) Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures. Eur Spine J 13(2):101–107CrossRefPubMed Been HD, Poolman RW, Ubags LH (2004) Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures. Eur Spine J 13(2):101–107CrossRefPubMed
4.
Zurück zum Zitat Beisse R, Potulski M, Beger J, Buhren V (2002) Development and clinical application of a thoracoscopy implantable plate frame for treatment of thoracolumbar fractures and instabilities. Orthopäde 31(4):413–422CrossRefPubMed Beisse R, Potulski M, Beger J, Buhren V (2002) Development and clinical application of a thoracoscopy implantable plate frame for treatment of thoracolumbar fractures and instabilities. Orthopäde 31(4):413–422CrossRefPubMed
5.
Zurück zum Zitat Berven S, Kao H, Deviren V, Hu S, Bradford D (2003) Treatment of thoracic pseudarthrosis in the adult: is combined surgery necessary? Clin Orthop Relat Res June(411):25-31 Berven S, Kao H, Deviren V, Hu S, Bradford D (2003) Treatment of thoracic pseudarthrosis in the adult: is combined surgery necessary? Clin Orthop Relat Res June(411):25-31
6.
Zurück zum Zitat Budny PG, Regan PJ, Roberts AH (1993) The estimation of blood loss during burns surgery. Burns 19(2):134–137CrossRefPubMed Budny PG, Regan PJ, Roberts AH (1993) The estimation of blood loss during burns surgery. Burns 19(2):134–137CrossRefPubMed
7.
Zurück zum Zitat Burgos J, Rapariz JM, Gonzalez-Herranz P (1998) Anterior endoscopic approach to the thoracolumbar spine. Spine 23(22):2427–2431CrossRefPubMed Burgos J, Rapariz JM, Gonzalez-Herranz P (1998) Anterior endoscopic approach to the thoracolumbar spine. Spine 23(22):2427–2431CrossRefPubMed
8.
Zurück zum Zitat Cunningham BW, Kotani Y, McNulty PS, Cappuccino A, Kanayama M, Fedder IL, McAfee PC (1998) Video-assisted thoracoscopic surgery versus open thoracotomy for anterior thoracic spinal fusion. A comparative radiographic, biomechanical, and histologic analysis in a sheep model. Spine 23(12):1333–1340CrossRefPubMed Cunningham BW, Kotani Y, McNulty PS, Cappuccino A, Kanayama M, Fedder IL, McAfee PC (1998) Video-assisted thoracoscopic surgery versus open thoracotomy for anterior thoracic spinal fusion. A comparative radiographic, biomechanical, and histologic analysis in a sheep model. Spine 23(12):1333–1340CrossRefPubMed
9.
Zurück zum Zitat De Peretti F, Hovorka I, Cambas PM, Nasr JM, Argenson C (1996) Short device fixation and early mobilization for burst fractures of the thoracolumbar junction. Eur Spine J 5(2):112–120CrossRefPubMed De Peretti F, Hovorka I, Cambas PM, Nasr JM, Argenson C (1996) Short device fixation and early mobilization for burst fractures of the thoracolumbar junction. Eur Spine J 5(2):112–120CrossRefPubMed
10.
Zurück zum Zitat Dehoux E, Barré J, Miraucourt T, Deprey F (1988) Value of the anterior approach in the treatment of fractures of the thoraco lumbar spine. Rev Chir Orthop 74(Suppl 2):296–298PubMed Dehoux E, Barré J, Miraucourt T, Deprey F (1988) Value of the anterior approach in the treatment of fractures of the thoraco lumbar spine. Rev Chir Orthop 74(Suppl 2):296–298PubMed
11.
Zurück zum Zitat Ebara S, Kamimura M, Itoh H, Kinoshita T, Takahashi J, Takaoka K, Ohtsuka K (2000) A new system for the anterior restoration and fixation of thoracic spinal deformities using an endoscopic approach. Spine 25(7):876–883CrossRefPubMed Ebara S, Kamimura M, Itoh H, Kinoshita T, Takahashi J, Takaoka K, Ohtsuka K (2000) A new system for the anterior restoration and fixation of thoracic spinal deformities using an endoscopic approach. Spine 25(7):876–883CrossRefPubMed
12.
Zurück zum Zitat Eysel P, Meinig G (1991) Comparative study of different dorsal stabilization techniques in recent thoraco-lumbar spine fractures. Acta Neurochir (Wien) 109(1–2):12–19CrossRef Eysel P, Meinig G (1991) Comparative study of different dorsal stabilization techniques in recent thoraco-lumbar spine fractures. Acta Neurochir (Wien) 109(1–2):12–19CrossRef
13.
Zurück zum Zitat Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L (1995) The surgical, medical perioperative complications of anterior spinal fusion surgery in the thoracic, lumbar spine in adults. A review of 1223 procedures. Spine 20(14):1592–1599CrossRefPubMed Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L (1995) The surgical, medical perioperative complications of anterior spinal fusion surgery in the thoracic, lumbar spine in adults. A review of 1223 procedures. Spine 20(14):1592–1599CrossRefPubMed
14.
Zurück zum Zitat Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia I. Paraplegia 7(3):179–192PubMed Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia I. Paraplegia 7(3):179–192PubMed
15.
Zurück zum Zitat Haas N, Blauth M, Tscherne H (1991) Anterior plating in thoracolumbar spine injuries. Indication, technique, and results. Spine 16(3 Suppl):S100–S111PubMedCrossRef Haas N, Blauth M, Tscherne H (1991) Anterior plating in thoracolumbar spine injuries. Indication, technique, and results. Spine 16(3 Suppl):S100–S111PubMedCrossRef
16.
Zurück zum Zitat Han PP, Kenny K, Dickman CA (2002) Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures. Neurosurgery 51(5 Suppl):88–95 Han PP, Kenny K, Dickman CA (2002) Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures. Neurosurgery 51(5 Suppl):88–95
17.
Zurück zum Zitat Hertlein H, Hartl WH, Piltz S, Schurmann M, Andress HJ (2000) Endoscopic osteosynthesis after thoracic spine trauma: a report of two cases. Injury 31(5):333–336CrossRefPubMed Hertlein H, Hartl WH, Piltz S, Schurmann M, Andress HJ (2000) Endoscopic osteosynthesis after thoracic spine trauma: a report of two cases. Injury 31(5):333–336CrossRefPubMed
18.
Zurück zum Zitat Hovorka I, de Peretti F, Damon F, Argenson C (2001) Videoscopic retropleural and retroperitoneal approach to the thoracolumbar junction of the spine. Rev Chir Orthop Reparatrice Appar Mot 87(1):73–78PubMed Hovorka I, de Peretti F, Damon F, Argenson C (2001) Videoscopic retropleural and retroperitoneal approach to the thoracolumbar junction of the spine. Rev Chir Orthop Reparatrice Appar Mot 87(1):73–78PubMed
19.
Zurück zum Zitat Huang TJ, Hsu RW, Liu HP, Liao YS, Hsu KY, Shih HN (1998) Analysis of techniques for video-assisted thoracoscopic internal fixation of the spine. Arch Orthop Trauma Surg 117(1-2):92–95CrossRefPubMed Huang TJ, Hsu RW, Liu HP, Liao YS, Hsu KY, Shih HN (1998) Analysis of techniques for video-assisted thoracoscopic internal fixation of the spine. Arch Orthop Trauma Surg 117(1-2):92–95CrossRefPubMed
20.
Zurück zum Zitat Huang TJ, Hsu RW, Sum CW, Sum CW, Liu HP (1999) Complications in thoracoscopic spinal surgery: a study of 90 consecutive patients. Surg Endosc 13(4):346–350CrossRefPubMed Huang TJ, Hsu RW, Sum CW, Sum CW, Liu HP (1999) Complications in thoracoscopic spinal surgery: a study of 90 consecutive patients. Surg Endosc 13(4):346–350CrossRefPubMed
21.
Zurück zum Zitat Khoo LT, Beisse R, Potulski M (2002) Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery 51(5 Suppl):104–117 Khoo LT, Beisse R, Potulski M (2002) Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery 51(5 Suppl):104–117
22.
Zurück zum Zitat Kirkpatrick JSWR, Likavec M, Emery SE, Ghanayem A (1995) Anterior stabilisation of thoraco-lumbar burst fractures using the Kaneda device: a preliminary report. Orthopedics 18(7):673–678PubMed Kirkpatrick JSWR, Likavec M, Emery SE, Ghanayem A (1995) Anterior stabilisation of thoraco-lumbar burst fractures using the Kaneda device: a preliminary report. Orthopedics 18(7):673–678PubMed
23.
Zurück zum Zitat Kirkpatrick JS (2003) Thoracolumbar fracture management: anterior approach. J Am Acad Orthop Surg 11(5):355–363PubMed Kirkpatrick JS (2003) Thoracolumbar fracture management: anterior approach. J Am Acad Orthop Surg 11(5):355–363PubMed
24.
Zurück zum Zitat Knop C, Fabian HF, Bastian L, Rosenthal H, Lange U, Zdichavsky M, Blauth M (2002) Fate of the transpedicular intervertebral bone graft after posterior stabilisation of thoracolumbar fractures. Eur Spine J 11(3):251–257CrossRefPubMed Knop C, Fabian HF, Bastian L, Rosenthal H, Lange U, Zdichavsky M, Blauth M (2002) Fate of the transpedicular intervertebral bone graft after posterior stabilisation of thoracolumbar fractures. Eur Spine J 11(3):251–257CrossRefPubMed
25.
Zurück zum Zitat Le Huec JC, Aunoble S, Magendie J, Hadidane R (2003) Video-assisted anterior approach to the spine. In: Surgical techniques in orthopeadics and traumatology, 2005; 55-060-D-10, 12 p Le Huec JC, Aunoble S, Magendie J, Hadidane R (2003) Video-assisted anterior approach to the spine. In: Surgical techniques in orthopeadics and traumatology, 2005; 55-060-D-10, 12 p
26.
Zurück zum Zitat Magerl F, Aebi M, Gertzbein SD, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184CrossRefPubMed Magerl F, Aebi M, Gertzbein SD, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184CrossRefPubMed
27.
Zurück zum Zitat McAfee PC, Regan JR, Zuckerman J, Picetti GD 3rd, Heim S, Geis WP, Fedder IL (1995) The incidence of complications in endoscopic anterior thoracolumbar spinal reconstructive surgery. A prospective multicenter study comprising the first 100 consecutive cases. Spine 20(14):1624–1632CrossRefPubMed McAfee PC, Regan JR, Zuckerman J, Picetti GD 3rd, Heim S, Geis WP, Fedder IL (1995) The incidence of complications in endoscopic anterior thoracolumbar spinal reconstructive surgery. A prospective multicenter study comprising the first 100 consecutive cases. Spine 20(14):1624–1632CrossRefPubMed
28.
29.
Zurück zum Zitat Nazarian SLC, Gauthier V, Bréhier P, Louis R (1996) Analyse des fractures thoraco-lombaires et lombaires traitées par voie antérieure. Rev Chir Orthop 82(Suppl 1):101–105 Nazarian SLC, Gauthier V, Bréhier P, Louis R (1996) Analyse des fractures thoraco-lombaires et lombaires traitées par voie antérieure. Rev Chir Orthop 82(Suppl 1):101–105
30.
Zurück zum Zitat Olinger A, Hildebrandt U, Mutschler W, Menger MD (1999) First clinical experience with an endoscopic retroperitoneal approach for anterior fusion of lumbar spine fractures from levels T12 to L5. Surg Endosc 13(12):1215–1219CrossRefPubMed Olinger A, Hildebrandt U, Mutschler W, Menger MD (1999) First clinical experience with an endoscopic retroperitoneal approach for anterior fusion of lumbar spine fractures from levels T12 to L5. Surg Endosc 13(12):1215–1219CrossRefPubMed
31.
Zurück zum Zitat Onimus M, Laurain JM, Fiore N, Ferre B (1989) Anterior vertebral reconstruction of the thoracic and lumbar spine using Hall-Dwyer instrumentation with distraction. Rev Chir Orthop Reparatrice Appar Mot 75(8):558–568PubMed Onimus M, Laurain JM, Fiore N, Ferre B (1989) Anterior vertebral reconstruction of the thoracic and lumbar spine using Hall-Dwyer instrumentation with distraction. Rev Chir Orthop Reparatrice Appar Mot 75(8):558–568PubMed
32.
Zurück zum Zitat Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM (2001) Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma 15(8):566–569CrossRefPubMed Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM (2001) Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma 15(8):566–569CrossRefPubMed
33.
Zurück zum Zitat Regan JJ, Mack MJ, Picetti GD 3rd (1995) A technical report on video-assisted thoracoscopy in thoracic spinal surgery. Preliminary description. Spine 20(7):831–837CrossRefPubMed Regan JJ, Mack MJ, Picetti GD 3rd (1995) A technical report on video-assisted thoracoscopy in thoracic spinal surgery. Preliminary description. Spine 20(7):831–837CrossRefPubMed
34.
Zurück zum Zitat Rosenthal D, Marquardt G, Lorenz R, Nichtweiss M (1996) Anterior decompression and stabilization using a microsurgical endoscopic technique for metastatic tumors of the thoracic spine. J Neurosurg 84(4):565–572CrossRefPubMed Rosenthal D, Marquardt G, Lorenz R, Nichtweiss M (1996) Anterior decompression and stabilization using a microsurgical endoscopic technique for metastatic tumors of the thoracic spine. J Neurosurg 84(4):565–572CrossRefPubMed
35.
Zurück zum Zitat Rosenthal D, Rosenthal R, de Simone A (1994) Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine 19(9):1087–1091CrossRefPubMed Rosenthal D, Rosenthal R, de Simone A (1994) Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine 19(9):1087–1091CrossRefPubMed
36.
Zurück zum Zitat Stagnara P, De Mauroy JC, Dran G, Gonon GP, Costanzo G, Dimnet J, Pasquet A (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine 7(4):335–342CrossRefPubMed Stagnara P, De Mauroy JC, Dran G, Gonon GP, Costanzo G, Dimnet J, Pasquet A (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine 7(4):335–342CrossRefPubMed
37.
Zurück zum Zitat Verheyden AP, Katscher S, Gonschorek O, Lill H, Josten C (2002) Endoscopically assisted minimally invasive reconstruction of the anterior thoracolumbar spine in prone position. Unfallchirurg 105(10):873–880CrossRefPubMed Verheyden AP, Katscher S, Gonschorek O, Lill H, Josten C (2002) Endoscopically assisted minimally invasive reconstruction of the anterior thoracolumbar spine in prone position. Unfallchirurg 105(10):873–880CrossRefPubMed
Metadaten
Titel
Video-assisted treatment of thoracolumbar junction fractures using a specific distractor for reduction: prospective study of 50 cases
verfasst von
Jean-Charles Le Huec
C. Tournier
S. Aunoble
K. Madi
Ph. Leijssen
Publikationsdatum
01.03.2010
Verlag
Springer-Verlag
Erschienen in
European Spine Journal / Ausgabe Sonderheft 1/2010
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-009-1121-7

Weitere Artikel der Sonderheft 1/2010

European Spine Journal 1/2010 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.