Minimally invasive lateral corpectomy for thoracolumbar traumatic burst fractures

Abstract

OBJECTIVEThe need for anterior column reconstruction after thoracolumbar burst fractures remains controversial. Here, the authors present their experience with minimally invasive lateral thoracolumbar corpectomies for traumatic fractures.METHODSBetween 2012 and 2019, 59 patients with 65 thoracolumbar fractures underwent 65 minimally invasive lateral corpectomies (MIS group). This group was compared to 16 patients with single-level thoracolumbar fractures who had undergone open lateral corpectomies with the assistance of general surgery between 2007 and 2011 (open control group). Comparisons of the two groups were made with regard to operative time, estimated blood loss, time to ambulation, and fusion rates at 1 year postoperatively. The authors further analyzed the MIS group with regard to injury mechanism, fracture characteristics, neurological outcome, and complications.RESULTSPatients in the MIS group had a significantly shorter mean operative time (228.3 ± 27.9 vs 255.6 ± 34.1 minutes, p = 0.001) and significantly shorter mean time to ambulation after surgery (1.8 ± 1.1 vs 5.0 ± 0.8 days, p < 0.001) than the open corpectomy group. Mean estimated blood loss did not differ significantly between the two groups, though the MIS group did trend toward a lower mean blood loss. There was no significant difference in fusion status at 1 year between the MIS and open groups; however, this comparison was limited by poor follow-up, with only 32 of 59 patients (54.2%) in the MIS group and 8 of 16 (50%) in the open group having available imaging at 1 year. Complications in the MIS group included 1 screw misplacement requiring revision, 2 postoperative femoral neuropathies (one of which improved), 1 return to surgery for inadequate posterior decompression, 4 pneumothoraces requiring chest tube placement, and 1 posterior wound infection. The rate of revision surgery for the failure of fusion in the MIS group was 1.7% (1 of 59 patients).CONCLUSIONSThe minimally invasive lateral thoracolumbar corpectomy approach for traumatic fractures appears to be relatively safe and may result in shorter operative times and quicker mobilization as compared to those with open techniques. This should be considered as a treatment option for thoracolumbar spine fractures.

Radiological Evaluation of Combined Anteroposterior Fusion with Vertebral Body Replacement Using a Minimally Invasive Lateral Approach for Osteoporotic Vertebral Fractures: Verification of Optimal Surgical Procedure

“…As MIST surgery has recently been more widely performed, vertebral corpectomy with a minimally invasive lateral approach similar to L-LIF is widely used, making it possible to perform combined anteroposterior VBR in a less invasive procedure than before [26,[28][29][30]. Corpectomy with a minimally invasive lateral approach can achieve a fixation with less adjacent tissue damage.…”

“…Corpectomy with a minimally invasive lateral approach can achieve a fixation with less adjacent tissue damage. Moreover, the proper use of these methods has been shown to shorten recovery times, as well as to reduce blood loss and perioperative complications [26].…”

“…Recently, the widespread use of minimally invasive spinal treatment (MIST) has made it possible to perform combined anteroposterior fusion with vertebral body replacement (VBR) using a wide footplate expandable cage with a minimally invasive lateral approach [24,25]. The anterior surgical approach can be performed in the same way as the minimally invasive lumbar-lateral interbody fusion (L-LIF) approach, and corpectomy can achieve a fixation with less adjacent tissue damage [26]. However, as this technique is relatively new, there is a lack of sufficient evidence to determine the optimal procedure, such as the surgical sequence or the range of fixation.…”

Minimally invasive lateral retroperitoneal transpsoas approach for lumbar corpectomy and fusion with posterior instrumentation

“…Based on his symptoms and imaging findings, we offered the patient a minimally invasive lateral retroperitoneal transpsoas approach for L3 and L4 corpectomies, L2–5 interbody fusion, and L2–5 minimally invasive posterior instrumentation. 2 – 4 Standard operative risks to nearby neural, bowel, and vascular structures applied, and alternative options included anterior corpectomy, posterior fusion without corpectomy, or no surgery. 5 L2–5 posterior instrumentation was chosen to safely minimize the construct length and biomechanical disruption.…”

Comparison of Navigated Expandable Vertebral Cage with Conventional Expandable Vertebral Cage for Minimally Invasive Lumbar/Thoracolumbar Corpectomy

“…Posterior fusion with transpedicular bone grafting after reduction for TLBF is a well-known and excellent procedure when the patient has no severe neurological compromise [ 7 ]. If the patient has severe symptoms due to the compression of collapsed vertebra, corpectomy is indicated [ 8 ]. The problem with major surgeries such as corpectomy and long posterior corrective fusion for elderly patients is the high rate of complications [ 9 ].…”