Anterior corpectomy via the mini-open, extreme lateral, transpsoas approach combined with short-segment posterior fixation for single-level traumatic lumbar burst fractures: analysis of health-related quality of life outcomes and patient satisfaction

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>The authors present clinical outcome data and satisfaction of patients who underwent minimally invasive vertebral body corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach and posterior short-segment instrumentation for lumbar burst fractures.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Patients with unstable lumbar burst fractures who underwent corpectomy and anterior column reconstruction via a mini-open, extreme lateral, transpsoas approach with short-segment posterior fixation were reviewed retrospectively. Demographic information, operative parameters, perioperative radiographic measurements, and complications were analyzed. Patient-reported outcome instruments (Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12]) and an anterior scar-specific patient satisfaction questionnaire were recorded at the latest follow-up.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Twelve patients (7 men, 5 women, average age 42 years, range 22–68 years) met the inclusion criteria. Lumbar corpectomies with anterior column support were performed (L-1, n = 8; L-2, n = 2; L-3, n = 2) and supplemented with short-segment posterior instrumentation (4 open, 8 percutaneous). Four patients had preoperative neurological deficits, all of which improved after surgery. No new neurological complications were noted. The anterior incision on average was 6.4 cm (range 5–8 cm) in length, caused mild pain and disability, and was aesthetically acceptable to the large majority of patients. Three patients required chest tube placement for pleural violation, and 1 patient required reoperation for cage subsidence/hardware failure. Average clinical follow-up was 38 months (range 16–68 months), and average radiographic follow-up was 37 months (range 6–68 months). Preoperative lumbar lordosis and focal lordosis were significantly improved/maintained after surgery. Patients were satisfied with their outcomes, had minimal/moderate disability (average ODI score 20, range 0–52), and had good physical (SF-12 physical component score 41.7% ± 10.4%) and mental health outcomes (SF-12 mental component score 50.2% ± 11.6%) after surgery.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Anterior corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach supplemented by short-segment posterior instrumentation is a safe, effective alternative to conventional approaches in the treatment of single-level unstable burst fractures and is associated with excellent functional outcomes and patient satisfaction.</jats:p></jats:sec>

Combined posterior percutaneous pedicle screw fixation with delayed anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures

“…To overcome the disadvantages of anterior-only and posterior-only approach, many authors have reported satisfactory results with a combined anterior-posterior approach [8][9][10][11]. However, it was generally believed that the conventional combined anterior-posterior approach has more surgical invasiveness and morbidity than those of an anterior-only or posterior-only approach.…”

“…There are numerous minimally invasive combined posterior-anterior techniques have attempted to decrease the associated morbidity. These have included combining vertebral augmentation with pedicle screw instrumentation [5,6], transpedicular corpectomy with expandable cage combined with pedicle screw fixation [7], and minimally invasive corpectomy and posterior pedicle instrumentation [8,9]. However, the optimal surgical treatment strategy for unstable thoracolumbar burst fractures remains controversial.…”

Spontaneous Corpectomy and Anterior Arthrodesis in Lumbar Spine : How Ankylosing Spondylitis Can Resolve a Vertebral Fracture

“…In fact the risk of another vertebral fracture increases 5-fold after the first event ('domino-effect'). These conditions must be considered in case of an open approach, especially in order to identify the correct level to treat and to select the appropriate surgery instrumentation, because in this cases there is and high risk of fixation failure (4)(5)(6). In this case, probably, the ability of the vertebral body to fuse itself, induced by the Ankylosing Spondylitis, prevailed on the worsening of the fracture, reaching a balance and obtaining a natural resolution.…”

Minimally invasive surgery for thoracolumbar spinal trauma

“…These complications included durotomies, intercostal neuralgia, deep venous thrombosis, pleural effusion, hemothorax, wound infection and hardware failure. Another study focusing on corpectomies for unstable lumbar burst fractures in 12 patients showed that when supplemented with short-segment posterior fixation this approach improved local lordosis, had good patient satisfaction outcomes and was tolerated well with minimal pain and morbidity (45). In their series, three of the patients required a chest tube for pleural violation and 1 patient required reoperation for cage subsidence/hardware failure.…”