General Session: MIS-1
Presented by: M. Balsano - View Audio/Video Presentation (Members Only)
M. Balsano(1), A. Zachos(1), G.R. Mosele(2), C. Doria(2)
(1) Regional Spinal Department, Santorso, Italy
(2) Orthopedic University Clinic, Sassari, Jordan
Introduction: Traditional corpectomy of the Thoraco-Lumbar spine can be obtained through an open approach, typical known as thoracophrenolumbotomy, that can be related to a high grade of complication's rate and a long hospitalization period. Many alternatives are available , including endoscopic techniques and posterior approaches: the first has been slow due to extensive and expensive instrumentation, difficult learning curve and possible conversion to open approach; the second is characterized by an extensive disruption of the muscles and sacrifice of nerve roots for achieving an adequate space for the placing of the cage, and the incidence of infection is higher due to the extensive instrumentation and blood loss. The mini-open lateral approach is a valid alternative to the conventional approaches, safer with less rate of complications.This study describes the results of treatment and outcome of 35 patients, treated from 2010 to 2015 in 2 italian institutes .
Material and Methods: A retrospective review of 35 patients treated from 2010 to 2015 has been done.The average age of the patients was 57.2 yrs, (range 23.3-67.3). Vertebral body replacement was performed using the wide footprint expandable Titanium cage X-core, Nuvasive.Monitoring was perfomormed using the free-run directionally stimulated EMG and for the TH-L junction the SSEP and MEP probes (M5, Nuvasive)The pathological conditions treated were: 7 congenital Th-L kyphosis, 12 spinal metastasis and 16 post-traumatic kyphosys.The levels: 9 cages in L3, 5 in L2, 11 in L1, 7 in T12 and 3 in T11.All the approaches have been performed using the sequential tube dilation and the placement of an expandable retractor (MaxAccess, Nuvasive).Clinical and radiographic data have been collected, evaluating segmental kyphosys, lumbar lordosis, VAS, ODI, peri and postoperative morbidity, complications' rate and fusion achieved.27 patients have been further stabilized posteriorly with a pedicular percutaneous instrumentation (Preceps, Nuvasive), while in 8 cases a lateral plate has been placed (Traverse, Nuvasive), achieving a full biomechanic control.RESULTSAll 35 patients had preoperative and postoperative radiographs. The average clinical and radiological follow-up was 26 months (range 6-45 months).The preoperative local kyphosys had an average angle of +25° (range +15; +43) and the lordosis had an average angle of - 35° (range -24; -13°).After the correction procedure the local kyphosys had increased to an average of -3° (range -9°; +15°) and the lordosis had increased to - 55° (range -29°; -63°).The VAS has decreased from an average of 6.5 (range 8-5) to an average of 2.7 (range 5-0).The ODI score had decreased from an average of 55% (range 40-75) to an average of 25% (range 15-35).We had observed 3 complications (8.5%) : 1 pleural effusion and 2 emothorax; the fusion rate had been of 85% ; no infections were observed.
Conclusions: The mini-open lateral approach for corpectomy in the thoracolumbar spine represents a middle-ground between open and endoscopic approaches,allowing for a minimally disruptive approach through a small incision with direct visualization of the pathology and utilization of conventional corpectomy techniques. We think that the clinical and radiographic results obtained in our study are very satisfactory and that this technique is a real and safer alternative to the other procedures.