J Korean Neurotraumatol Soc JKNTS Journal of Korean Neurotraumatology Society 1738-8708 Korean Neurotraumatology Society 10.13004/jknts.2011.7.1.24 Clinical Article Clinical and Radiological Analysis of Thoracoscopic Spinal Surgery in Thoracolumbar Burst Fracture Jung Jong Rak MD Park Sung Bae 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 04 2011 30 04 2011 7 1 24 28 02 12 2010 14 02 2011 11 04 2011 Copyright © 2011 Korean Neurotraumatology Society 2011 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.

 Thoracoscopy Thoracolumbar Spine Fracture

The authors have no financial conflicts of interest.

 Bartels RH Peul WC Mini-thoracotomy or thoracoscopic treatment for medially located thoracic herniated disc? Spine (Phila Pa 1976) 2007 32 E581 E584 Coltharp WH Arnold JH Alford WC Jr Burrus GR Glassford DM Jr Lea JW 4th Videothoracoscopy: improved technique and expanded indications Ann Thorac Surg 1922 53 776 778 Dickman CA Rosenthal D Karahalios DG Paramore CG Mican CA Apostolides PJ Thoracic vertebrectomy and reconstruction using a microsurgical thoracoscopic approach Neurosurgery 1996 38 279 293 Han PP Kenny K Dickman CA Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures Neurosurgery 2002 51 S88 S95 Harrop JS Vaccaro AR Hurlbert RJ Wilsey JT Baron EM Shaffrey CI Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. Invited submission from the Joint Section Meeting On Disorders of the Spine and Peripheral Nerves, March 2005 J Neurosurg Spine 2006 4 118 122 Horowitz MB Moossy JJ Julian T Ferson PF Huneke K Thoracic discectomy using video assisted thoracoscopy Spine (Phila Pa 1976) 1994 19 1082 1086 Huang TJ Hsu RW Liu HP Hsu KY Liao YS Shih HN Video-assisted thoracoscopic treatment of spinal lesions in the thoracolumbar junction Surg Endosc 1997 11 1189 1193 Khoo LT Beisse R Potulski M Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases Neurosurgery 2002 51 S104 S117 Kim SJ Sohn MJ Ryoo JY Kim YS Whang CJ Clinical Analysis of Video-assisted Thoracoscopic Spinal Surgery in the Thoracic or Thoracolumbar Spinal Pathologies J Korean Neurosurg Soc 2007 42 293 299 Landreneau RJ Mack MJ Hazelrigg SR Dowling RD Acuff TE Magee MJ Video-assisted thoracic surgery: basic technical concepts and intercostal approach strategies Ann Thorac Surg 1992 54 800 807 Lewis RJ Caccavale RJ Sisler GE Imaged thoracoscopic surgery: a new thoracic technique for resection of mediastinal cysts Ann Thorac Surg 1992 53 318 320 Longo UG Papatietro N Maffulli N Denaro V Thoracoscopy for minimally invasive thoracic spine surgery Orthop Clin North Am 2009 40 459 464 Mack MJ Regan JJ Bobechko WP Acuff TE Application of thoracoscopy for diseases of the spine Ann Thorac Surg 1993 56 736 738 McCormack T Karaikovic E Gaines RW The load sharing classification of spine fractures Spine (Phila Pa 1976) 1994 19 1741 1744 Niemeyer T Freeman BJ Grevitt MP Webb JK Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity Eur Spine J 2000 9 499 504 Rosenthal D Dickman CA Thoracoscopic microsurgical excision of herniated thoracic discs J Neurosurg 1998 89 224 235 Rosenthal D Rosenthal R de Simone A Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique Spine (Phila Pa 1976) 1994 19 1087 1091

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

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

This picture shows the partial corpectomy site of thoracic vertebra.

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

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.

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

McCormck's classification

The characteristics of patients

TLISS: thoracolumbar injury severity score

The clinical and radiological outcomes

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