Clinical and Radiological Analysis of Thoracoscopic Spinal Surgery in Thoracolumbar Burst Fracture

Jong Rak Jung; Sung Bae Park

doi:10.13004/jknts.2011.7.1.24

Journal List > J Korean Neurotraumatol Soc > v.7(1) > 1084092

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Jung and Park: Clinical and Radiological Analysis of Thoracoscopic Spinal Surgery in Thoracolumbar Burst Fracture

Clinical Article

Journal of Korean Neurotraumatology Society 2011; 7(1): 24-28.

Published online: 30 April 2011

DOI: https://doi.org/10.13004/jknts.2011.7.1.24

Clinical and Radiological Analysis of Thoracoscopic Spinal Surgery in Thoracolumbar Burst Fracture

Jong Rak Jung, MD, Sung Bae Park, MD

Department of Neurosurgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea.

Address for correspondence: Sung Bae Park, MD. Department of Neurosurgery, Inje University College of Medicine, Seoul Paik Hospital, 85 Jeo-dong 2-ga, Jung-gu, Seoul 100-032, Korea. Tel: +82-2-2270-0029, Fax: +82-2-2270-0573, ddolbae01@naver.com

Received 2 December 2010 Revised 14 February 2011 Accepted 11 April 2011

Abstract

Objective

To evaluate the effectiveness and reasonability of thoracoscopic spinal surgery in patients with thoracolumbar burst fractures.

Methods

The authors reviewed the patients who had undergone thoracoscopic spine surgery for thoracolumbar burst fracture between January 2008 and October 2010. Spine lateral radiographs were taken at preoperative and follow-up periods and thoracolumbar kyphosis (T11-L2 Cobb angle) was measured. Oswestry disability index (ODI) and Visual analogue scale (VAS) scores were also measured preoperatively and follow-up.

Results

There were three male patients and 2 female patients and a mean age of patients was 51.6±14.38 years. Mean follow-up duration was 14.0±7.8 months. The mean ODI score in follow-up period was significantly improved (40±1.5 and 13±11.4, p=0.043). The difference between preoperative and follow-up mean VAS scores was significant (8±1.1 and 1±1.7, p=0.042). Mean preoperative kyphotic angle was 21.4±6.48 degree and mean follow-up kyphotic angle was 10.3±7.41 degree. There was significant difference (p=0.036). One patient complained a transient intercostal neuralgia and there was postoperative chylothorax in other patient.

Conclusion

In this study, there are good clinical and radiological results after thoracoscopic spine surgery in short-term period. Although thoracoscopic spine surgery requires a steep learning curve, it could be a promising technique with good results in thoracolumbar burst fracture.

Keywords: Thoracoscopy, Thoracolumbar, Spine, Fracture

Figures and Tables

FIGURE 1

Portal placement. The working portals are located between anterior and middle axillary line and the triangulation should be considered.

FIGURE 2

The first screw of MACS TL plate system (Aesculap) is inserted into the caudal vertebral body.

FIGURE 3

This picture shows the partial corpectomy site of thoracic vertebra.

FIGURE 4

This picture shows the intraoperative view of cage and bone segment insertions.

FIGURE 5

Postoperatively anteroposterior (A) and lateral (B) plain films show T12 burst fracture and postoperatively anteroposterior (C) and lateral (D) plain films show partial corpectomy and circumferential fixation at thoracolumbar vertebrae.

TABLE 1

Thoracolumbar injury severity score (TLISS) system

The score is the total of 3 components: injury mechanism, neurologic status, and PLC distruption. A score of ≤3 suggests nonoperative treatment, 4, operative or nonoperative treatment, and ≥5 suggests operative treatment

TABLE 2

McCormck's classification

TABLE 3

The characteristics of patients

TLISS: thoracolumbar injury severity score

TABLE 4

The clinical and radiological outcomes

^*p<0.05. +: Chylothroax, ++: Transient intercostal neuralgia, ODI: Oswestry disability index, VAS: Visual analogue scale

Notes

The authors have no financial conflicts of interest.

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