Mini-open anterior approach for corpectomy in the thoracolumbar spine

Article Article scientifique Article Mini-open anterior approach for corpectomy in the thoracolumbar spine eng 2008 author Payer Michael 655867 author Sottas Cyrille Christian 106539 25-31;discussion31-2 10.1016/j.surneu.2007.01.075 18054609 0090-3019 BACKGROUND: Traditional open anterior approaches to the TL spine were reported with a significant morbidity from a large wound field; therefore, "minimally invasive" thoracoscopic and laparoscopic anterior approaches have been recently introduced. However, these endoscopic techniques require a long and steep learning curve, require expensive disposable endoscopy material, and may be little suited for complication management. Alternatively, "mini-open" anterior approaches with table-mounted retractor systems have also been recently introduced. METHODS: Thirty-seven patients underwent a single-level thoracic or lumbar corpectomy and cage reconstruction for an unstable traumatic burst fracture or vertebral body tumor. A transthoracic (n = 6), transthoracic transdiaphragmatic (n = 23), or retroperitoneal (n = 8) mini-open approach was conducted with the SynFrame (Stratec Medical, Oberdorf, Switzerland) table-mounted retractor. Prior posterior pedicle screw fixation was performed in 35 of 37 patients. RESULTS: The mean surgical duration of the anterior approach was 181 minutes, and the average blood loss was 632 mL. There was no neurological worsening. On a VAS from 0 to 10, the mean local pain from the anterior approach was 1.7 at 6 months postoperatively, 1.4 at 12 months, and 1.0 at 24 months. Construct stability was found in all patients at 6 months after surgery. Six transient complications occurred. CONCLUSIONS: The mini-open anterior approach for corpectomy in the TL spine is safe, reliable, and economical. The table-mounted SynFrame retractor provides a stable operating field through which a familiar direct 3-dimensional view of the anterior TL spine is obtained with limited approach morbidity. This technique is an excellent alternative to thoracoscopic or laparoscopic procedures, avoiding the steep learning curve, technical difficulties, and equipment costs of endoscopic procedures. Adult Aged Cohort Studies Female Humans Lumbar Vertebrae/injuries Male Middle Aged Orthopedic Procedures/instrumentation/methods Retrospective Studies Spinal Fractures/surgery Spinal Neoplasms/surgery Surgical Procedures Minimally Invasive Thoracic Vertebrae/injuries Treatment Outcome Dewey 616.8 61 Département des neurosciences cliniques 226 false Surgical neurology 69 1 05e21338-6782-42ab-b76c-fbc541002f88 Supplemental data Restricted Discussion 18054609.pdf 44099 application/pdf c1295c45-6462-40a2-86c7-7017a59cbe54 Article (Accepted version) Restricted 18054609.pdf 330549 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques

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Mini-open anterior approach for corpectomy in the thoracolumbar spine	Surgical neurology			2008	682	0

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Sottas, Cyrille Christian