New Treatment Resources of Traumatic Thoracolumbar Burst Fractures - Minimally Invasive Open Anterior Column Reconstruction: our Initial Experience

Introduction. Thoracolumbal burst fracture is a common pathology in spinal trauma surgery. Most important for the understanding and treatment spinal injuries is to recognize spinal stability or instability as for unstable injuries stabilisation is recommended. Posterior only stabilisation leads to a high incidence of implant failure and re-kyphosis in the long-term, and patients with implant failure have moderate-to-severe pain. 80-85% of axial forces on the spine are transmitted via the anterior vertebral column. The aim of the procedure is to restore anatomical alignment and integrity to unstable or destroyed segments of the anterior column of the thoracic and lumbar spine. An open minimally invasive surgical approach is used to minimise surgical trauma and to reduce perioperative and postoperative morbidity Aim of the Study. We analyzed our initial experience in spinal anterior column stabilization for thoracolumbar burst fractures. Materials and methods. We have reviewed first 37 patients with thoracolumbar burst fracture wich have undergone anterior column stabilization in the Department of Spine Surgery of Trauma and Orthopaedic hospital between september 2007- september 2010. Results. We initially reported a series of 37 consecutive patients (14 women, 23 men) who were treated with minimally invasive open surgery to the anterior column between september 2007 and september 2010. There were 5 fractures of the thoracic spine (T4-10),17 fractures involving the thoracolumbar junction (T11-L1) and 15 fractures of the lumbar spine (L2-4). The most affected level was L1 (11 patients). In 5 cases anterior and posterior surgery were performed in one day. In 4 patients a right-sided mini-thoracotomy and 1 left sided minithoracotomy was performed to access the midthoracic spine (T4-8), a left-sided mini-thoracotomy to reach the thoracolumbar junction (T9-L1) was used in 14 patients and a retroperitoneal minilateral approach was used in 18 patients for lumbar spine intervention (L2-L4). Allogenous iliac crest bone was harvested in 11 patients and iliac crest autografts in 1 patient. Expandable (Synex) cages were used for vertebral reconstruction in 9 patients, but expandable (Obelisc) cages were used in 8 patients, nonexpandable mesh cages(DePuy) were used in 2 cases, tricortical iliac crest bone plus screw and rod system Expedium anterior (DePuy) - in 12 patients. Tricortical iliac crest bone or expandable cage plus locking compression plate (Synthes) in 3 patients. Conclusions. Our initial experience encourages us to continue this type of operation as it proved to be a safe for patients, the stability of the spine is much higher and anterior column stabilisation protects the spine.