Clinical outcomes of unstable thoracolumbar junction burst fractures: combined posterior short-segment correction followed by thoracoscopic corpectomy and fusion

May 17, 2013Acta neurochirurgica

Treatment results for unstable fractures at the lower spine using short back surgery followed by minimally invasive chest surgery and spine fusion

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Abstract

Ninety percent of patients demonstrated radiographic evidence of fusion after treatment for unstable thoracolumbar burst fractures.

Thirty-two patients with burst fractures at the thoracolumbar junction (T10 to L1) were treated.
At a mean follow-up of 20.4 months, 91% retained correction of their kyphotic deformity.
Three complications were reported in the patient series.
Short-segment posterior fusion followed by thoracoscopic anterior corpectomy may reduce morbidity compared to traditional open surgical methods.
This approach facilitates stabilization of both anterior and posterior columns of the spine.

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BACKGROUND: There is significant controversy surrounding the ideal management of thoracolumbar burst fractures. While several treatment and management algorithms have been proposed, the ideal treatment strategy for these fractures remains unsettled. The authors review their experience with short-segment posterior fusion followed by anterior thoracoscopic corpectomy for the treatment of unstable thoracolumbar burst fractures.

METHODS: We identified all patients treated by a single surgeon at our institution from 2002 to 2009 with short-segment posterior fusion followed by anterior thoracoscopic corpectomy for unstable thoracolumbar junction burst fractures. Demographic data, mechanism of injury, classification of fracture, Cobb angle, American Spinal Injury Association score, associated injuries, tobacco use, follow-up duration, and radiographic studies were all collected. Outcomes were assessed for fracture alignment (preoperative, postoperative, and long-term follow-up kyphosis), rate of fusion, neurological outcome, and treatment complications.

RESULTS: Thirty-two patients with burst fracture of the thoracolumbar junction defined as T10 to L1 were included. At a mean follow-up of 20.4 months, 90 % of patients had demonstrated radiographic evidence of fusion and 91 % retained the correction of their kyphotic deformity. There were three complications in the series.

CONCLUSIONS: Short-segment posterior fusion with thoracoscopic anterior corpectomy represents an alternative to traditional open treatment of thoracolumbar burst fractures. A thoracoscopic approach allows for a short-segment posterior fusion, reducing the loss of adjacent motion segments, minimizes morbidity associated with traditional open anterior approaches, allows for anterior and posterior column stabilization, and is associated with a high rate of bony fusion.

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Clinical outcomes of unstable thoracolumbar junction burst fractures: combined posterior short-segment correction followed by thoracoscopic corpectomy and fusion

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