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The State of the Art in Minimally Invasive Spine Surgery. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6194016. [PMID: 28337454 PMCID: PMC5350391 DOI: 10.1155/2017/6194016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 02/05/2023]
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Video-Assisted Thoracoscopic Surgery and Minimal Access Spinal Surgery Compared in Anterior Thoracic or Thoracolumbar Junctional Spinal Reconstruction: A Case-Control Study and Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6808507. [PMID: 28101511 PMCID: PMC5215450 DOI: 10.1155/2016/6808507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/16/2016] [Accepted: 12/01/2016] [Indexed: 12/01/2022]
Abstract
There are no published reports that compare the outcomes of video-assisted thoracoscopic surgery (VATS) and minimal access spinal surgery (MASS) in anterior spinal reconstruction. We conducted a retrospective case-control study in a single center and systematically reviewed the literature to compare the efficacy and safety of VATS and MASS in anterior thoracic (T) and thoracolumbar junctional (TLJ) spinal reconstruction. From 1995 to 2012, there were 111 VATS patients and 76 MASS patients treated at our hospital. VATS patients had significantly (p < 0.001) longer operating times and significantly (p < 0.022) higher thoracotomy conversion rates. We reviewed 6 VATS articles and 10 MASS articles, in which there were 625 VATS patients and 399 MASS patients. We recorded clinical complications and a thoracotomy conversion rate from our cases and the selected articles. The incidence of approach-related complications was significantly (p = 0.021) higher in VATS patients. The conversion rate was 2% in VATS patients and 0% in MASS patients (p = 0.001). In conclusion, MASS is associated with reduction in operating time, approach-related complications, and the thoracotomy conversion rate.
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Lee CY, Huang TJ, Li YY, Cheng CC, Wu MH. Comparison of minimal access and traditional anterior spinal surgery in managing infectious spondylitis: a minimum 2-year follow-up. Spine J 2014; 14:1099-105. [PMID: 24129050 DOI: 10.1016/j.spinee.2013.07.470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 06/20/2013] [Accepted: 07/22/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Traditional anterior spinal surgery (TASS) for the thoracolumbar spine is associated with significant morbidities. To avoid excessive tissue damage, minimal access spinal surgery (MASS) has been developed to treat a variety of anterior spinal disorders at the authors' institution. No previous reports comparing the outcomes of MASS and TASS for the treatment of infectious spondylitis were noted in the literature, to our knowledge. PURPOSE The aim of this study was to investigate the outcomes of MASS in managing infectious spondylitis and compare the results to TASS with a minimum follow-up of 2 years. STUDY DESIGN A retrospective comparative cohort study in a single center. PATIENT SAMPLE Forty patients with thoracic or lumbar infectious spondylitis who underwent anterior spinal surgery were enrolled. OUTCOME MEASURES Perioperative data including operative time, estimated blood loss, packed red blood cell transfusion, postoperative tube drainage, need for intensive care, and length of hospital stay. Postoperative complications were classified according to the Clavien-Dindo system. Fusion grade was assessed by plain radiographs on the basis of Burkus criteria. METHODS Between January 2002 and June 2010, all enrolled patients were collected via the Spine Operation Registry of the authors' institution. There were 23 MASS patients and 17 TASS patients. The average follow-up was 4.2 years (range, 2-9 years). RESULTS The mean estimated blood loss in MASS and TASS groups was 521.7 versus 979.4 mL (p=.007), intraoperative transfusion of packed red blood cells was 0.9 versus 2.7 units (p=.019), the amount of postoperative tube drainage was 235.2 versus 454.3 mL (p=.005), the number of patients requiring postoperative intensive care was 2 versus 7 (p=.023), and length of hospital stay was 15.4 versus 22.9, respectively (p=.043). The overall complication rate in the MASS group was 17% and 59% in the TASS group (p=.007). No major complications occurred in the MASS group, whereas four occurred in the TASS group (p=.026). Bone graft union was achieved in 38 of 39 survival patients (97%), with no difference between the groups. One patient in TASS had a pseudarthrosis and needed a posterior instrumented fusion. CONCLUSIONS Minimal access spinal surgery has been suggested to be an effective and safe technique in treating thoracic and lumbar infectious spondylitis. Minimal access spinal surgery did not need endoscopic equipments or complex surgical instruments. Furthermore, in comparison to TASS, MASS resulted in a reduced blood transfusion amount, decreased intensive care unit stay, reduced overall length of stay, and reduced surgical complication rate. Nevertheless, the risks may be increased in performing MASS on patients with multilevel involvement, which could be associated with high vascularity, alternated vascular anatomy, increased soft-tissue edema, and adhesion.
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Affiliation(s)
- Ching-Yu Lee
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia-Pu Rd., PuTz, Chiayi 613, Taiwan
| | - Tsung-Jen Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia-Pu Rd., PuTz, Chiayi 613, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist., Keelung 204, Taiwan; Departments of Medicine and Traditional Chinese Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1(st) Rd., Guishan, Taoyuan 333, Taiwan.
| | - Yen-Yao Li
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia-Pu Rd., PuTz, Chiayi 613, Taiwan; Departments of Medicine and Traditional Chinese Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1(st) Rd., Guishan, Taoyuan 333, Taiwan
| | - Chin-Chang Cheng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia-Pu Rd., PuTz, Chiayi 613, Taiwan; Departments of Medicine and Traditional Chinese Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1(st) Rd., Guishan, Taoyuan 333, Taiwan
| | - Meng-Huang Wu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia-Pu Rd., PuTz, Chiayi 613, Taiwan
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Thoracoscopic decompression in Pott's spine and its long-term follow-up. INTERNATIONAL ORTHOPAEDICS 2012; 36:331-7. [PMID: 22215368 DOI: 10.1007/s00264-011-1453-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 11/27/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Video-assisted thoracoscopic surgery (VATS) has become an alternative tool for a variety of spinal conditions as this approach minimises much morbidity related to conventional thoracotomy. The purpose of this study was to determine the efficacy of VATS and its long-term results in patients with dorsal spinal tuberculosis. MATERIALS AND METHODS This retrospective long-term follow-up study of VATS-assisted surgical treatment of dorsal spine tuberculosis included 30 patients with a mean age of 33.5 years (range 15-60). Patients with dorsal spine tuberculosis who were suitable surgical candidates for VATS underwent a three-portal thoracoscopy for decompression with/without fusion of the spine along with routine chemotherapy for tuberculosis (TB). Patients were assessed for blood loss, duration of surgery, postoperative incision pain, duration of hospital stay, neurological recovery, and progression of deformity. Patients were observed for a minimum of five years. RESULTS The mean duration of surgery was 158.8 min (range 90-220 min) with mean blood loss of 296.7 ml (range 200-450 ml). Complications were seen in ten patients. The mean follow-up was 80 months (range 60-90 months) with neurological improvement and return of ambulatory power in all patients at final follow-up. There was an average increase in kyphus angle by 7.5° at final follow-up and 95% of patients achieved an excellent or good subjective outcome. CONCLUSION VATS-assisted surgical decompression can be a safe and effective technique for anterior debridement and fusion in tuberculosis of the dorsal spine to achieve neurological recovery with reduced morbidity, blood loss, and hospital stay compared to thoracotomy.
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Comparison between 4.0-mm stainless steel and 4.75-mm titanium alloy single-rod spinal instrumentation for anterior thoracoscopic scoliosis surgery. Spine (Phila Pa 1976) 2008; 33:2173-8. [PMID: 18794758 DOI: 10.1097/brs.0b013e31817f9415] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of a consecutive, single surgeon case series. OBJECTIVE To compare minimum 2-year postoperative outcomes between 4.0-mm stainless steel and 4.75-mm titanium alloy single-rod anterior thoracoscopic instrumentation for the treatment of thoracic idiopathic scoliosis. SUMMARY OF BACKGROUND DATA Advances in anterior thoracoscopic spinal instrumentation for scoliosis have attempted to mitigate the postoperative complications of rod failure, pseudarthrosis, and deformity progression. Biomechanical data suggest that the 4.75-mm titanium construct has a lower risk of fatigue failure compared to the 4.0-mm stainless steel construct. METHODS Sixty-four consecutive anterior thoracoscopic spinal instrumentation cases in patients with thoracic scoliosis performed by a single surgeon and with minimum 2-year follow-up were retrospectively reviewed. The first 34 cases used a 4.0-mm stainless steel (SS) construct, whereas the subsequent 30 cases used a 4.75-mm titanium (Ti) alloy instrumentation system. The first 10 SS cases and the first 5 Ti cases were excluded from the statistical comparison to account for a potential learning curve effect. A multivariate analysis of variance (P < 0.05) was used to compare radiographic, perioperative, and postoperative complication data between patients surgically treated with the 2 different instrumentation systems. RESULTS Patients in the SS group (n = 24) underwent surgery from 2000 to 2001, whereas patients in the Ti group (n = 25) underwent surgery from 2002 to 2004. The mean age at surgery, gender ratio, length of hospitalization, estimated blood loss, and operative time were not statistically different between the 2 patient groups (P > 0.13). The average follow-up in the SS group was, however, significantly longer than in the Ti group (4.0 +/- 1.4 years vs. 2.3 +/- 1.0 years; P = 0.001). Preop main thoracic Cobb angles were similar between the 2 groups (P = 0.62); however, the 2-year main thoracic Cobb was significantly smaller (P = 0.03) and the 2-year percent correction was significantly greater in the Ti group (P = 0.03). Five patients (21%) in the SS group had a pseudarthrosis, 3 (13%) experienced rod failure, and 2 (8%) required a revision posterior spinal fusion. In the Ti group, 2 patients (8%) had a pseudarthrosis, and no patient experienced rod failure or required a revision procedure. CONCLUSION Although the average follow-up in the Ti group was significantly shorter than in the SS group, the 4.75-mm titanium alloy construct resulted in improved maintenance of deformity correction at 2-years postop and a lower incidence of instrumentation-related complications (pseudarthrosis, rod breakage, and surgical revisions) compared to the 4.0-mm stainless steel construct. Improved outcomes with the titanium alloy construct are likely because of the mechanical properties of the implant, refined patient selection criteria, and greater surgical experience gained with time.
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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; 42:293-9. [PMID: 19096559 DOI: 10.3340/jkns.2007.42.4.293] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 08/29/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Thoracoscopic spinal surgery provides minimally invasive approaches for effective vertebral decompression and reconstruction of the thoracic and thoracolumbar spine, while surgery related morbidity can be significantly lowered. This study analyzes clinical results of thoracoscopic spinal surgery performed at our institute. METHODS Twenty consecutive patients underwent video-assisted thoracosopic surgery (VATS) to treat various thoracic and thoracolumbar pathologies from April 2000 to July 2006. The lesions consisted of spinal trauma (13 cases), thoracic disc herniation (4 cases), tuberculous spondylitis (1 case), post-operative thoracolumbar kyphosis (1 case) and thoracic tumor (1 case). The level of operation included upper thoracic lesions (3 cases), midthoracic lesions (6 cases) and thoracolumbar lesions (11 cases). We classified the procedure into three groups: stand-alone thoracoscopic discectomy (3 cases), thoracoscopic fusion (11 cases) and video assisted mini-thoracotomy (6 cases). RESULTS Analysis on the Frankel performance scale in spinal trauma patients (13 cases), showed a total of 7 patients who had neurological impairment preoperatively : Grade D (2 cases), Grade C (2 cases), Grade B (1 case), and Grade A (2 cases). Four patients were neurologically improved postoperatively, two patients were improved from C to E, one improved from grade D to E and one improved from grade B to grade D. The preoperative Cobb's and kyphotic angle were measured in spinal trauma patients and were 18.9+/-4.4 degrees and 18.8+/-4.6 degrees , respectively. Postoperatively, the angles showed statistically significant improvement, 15.1+/-3.7 degrees and 11.3+/-2.4 degrees , respectively (P<0.001). CONCLUSION Although VATS requires a steep learning curve, it is an effective and minimally invasive procedure which provides biomechanical stability in terms of anterior column decompression and reconstruction for anterior load bearing, and preservation of intercostal muscles and diaphragm.
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Affiliation(s)
- Sung Jin Kim
- Department of Neurosurgery , Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Korea
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Jayaswal A, Upendra B, Ahmed A, Chowdhury B, Kumar A. Video-assisted thoracoscopic anterior surgery for tuberculous spondylitis. Clin Orthop Relat Res 2007; 460:100-7. [PMID: 17471105 DOI: 10.1097/blo.0b013e318065b6e4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In the absence of major deformity, the major goal of surgery in tuberculous spondylitis is to achieve adequate cord decompression and débridement of diseased tissue. We asked whether video-assisted thoracoscopic surgery (VATS) could be undertaken in active tuberculosis of the spine with instrumentation and achieve good healing of the disease with fusion and with adequate decompression of the cord to achieve neural recovery. We retrospectively reviewed 23 patients (13 men and 10 women with an average age of 38.2 years) with single-level thoracic spinal tuberculosis (T4-T11) treated with VATS. Of the 23 patients, 18 had paraparesis/paraplegia. The procedures included: (1) débridement and drainage of prevertebral and paravertebral abscess (n = 4); (2) débridement, decompression, and reconstruction with rib graft (n = 8); (3) débridement, decompression, anterior vertical titanium mesh cage, and open posterior screw-rod fixation (n = 5); and (4) débridement, decompression, and anterior screw-rod fixation (n = 6). Twenty-two of 23 patients achieved fusion and there was no recurrence of the disease in any of the patients. No patient had neurological deterioration and 17 of the 18 neurologically compromised patients regained ambulatory power. Small scars (for surgical portals), early mobilization, and short hospital stays were the salient advantages.
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Affiliation(s)
- Arvind Jayaswal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Ansari nagar, New Delhi 110029, India.
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Schultheiss M, Hartwig E, Kinzl L, Claes L, Wilke HJ. Thoracolumbar fracture stabilization: comparative biomechanical evaluation of a new video-assisted implantable system. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2004; 13:93-100. [PMID: 14634854 PMCID: PMC3476577 DOI: 10.1007/s00586-003-0640-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2002] [Revised: 08/29/2003] [Accepted: 09/19/2003] [Indexed: 10/26/2022]
Abstract
Minimally invasive techniques for spinal surgery are becoming more widespread as improved technologies are developed. Stabilization plays an important role in fracture treatment, but appropriate instrumentation systems for endoscopic circumstances are lacking. Therefore a new thoracoscopically implantable stabilization system for thoracolumbar fracture treatment was developed and its biomechanical in vitro properties were compared. In a biomechanical in vitro study, burst fracture stabilization was simulated and anterior short fixation devices were tested under load with pure moments to evaluate the biomechanical stabilizing characteristics of the new system in comparison with a currently available system. With interbody graft and fixation the new system demonstrated higher stabilizing effects in flexion/extension and lateral bending and restored axial stability beyond the intact spine, as well as having comparable or improved effects compared with the current system. Because of this biomechanical characterization a clinical trial is warranted; the usefulness of the new system has already been demonstrated in 45 patients in our department and more than 300 cases in a multicenter study which is currently under way.
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Affiliation(s)
- M. Schultheiss
- Department of Trauma, Hand and Reconstructive Surgery, University of Ulm, Ulm, Germany
| | - E. Hartwig
- Department of Trauma, Hand and Reconstructive Surgery, University of Ulm, Ulm, Germany
| | - L. Kinzl
- Department of Trauma, Hand and Reconstructive Surgery, University of Ulm, Ulm, Germany
| | - L. Claes
- Institute of Orthopedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - H.-J. Wilke
- Institute of Orthopedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, 89081 Ulm, Germany
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Schultheiss M, Kinzl L, Claes L, Wilke HJ, Hartwig E. Minimally invasive ventral spondylodesis for thoracolumbar fracture treatment: surgical technique and first clinical outcome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2003; 12:618-24. [PMID: 12898350 PMCID: PMC3467990 DOI: 10.1007/s00586-003-0564-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2002] [Revised: 01/28/2003] [Accepted: 04/04/2003] [Indexed: 10/26/2022]
Abstract
A new instrumentation system for ventral stabilization of the spine that can be used for an endoscopic and minimally invasive approach was developed. We describe the implantation technique and report on the first clinical results. This prospective study covers the first 45 patients to undergo this new technique since it was introduced in 1999. In all patients the operation was successfully performed in a completely minimally invasive procedure. Mono- and bisegmental stabilization was performed mainly at the thoracolumbar junction after initial posterior instrumentation in most cases. Lesions varied from fresh/old fractures to metastases (T5-L3). Pre- and postoperative follow-up included clinical examination and radiological visualization via X-ray and computed tomographic scan. Our experience with this minimally invasive procedure demonstrated the feasibility of the method.
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Affiliation(s)
- Markus Schultheiss
- Department of Trauma, Hand and Reconstructive Surgery, University of Ulm, Steinhövelstrasse 9, 89075 Ulm, Germany.
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Schultheiss M, Claes L, Wilke HJ, Kinzl L, Hartwig E. Enhanced primary stability through additional cementable cannulated rescue screw for anterior thoracolumbar plate application. J Neurosurg 2003; 98:50-5. [PMID: 12546388 DOI: 10.3171/spi.2003.98.1.0050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors conducted a study to investigate the biomechanical in vitro influence of a new anchorage system for fixation of anterior stabilization devices and the possibility of using additional cement after screw insertion to compensate for poor bone quality. The incidence of osteoporosis-related fractures has increased nearly twofold in the last decade. Because of problems associated with anterior screw fixation such as loosening, mechanical failure, and the weakness of osteoporotic bone, current surgical treatments of vertebral body (VB) fractures are problematic. This is due to poor fixation strength of anterior screws in the adjacent segments. The aim of this study was to determine whether a new cemented and uncemented VB screw provides improved primary stability following placement of anterior instrumentation in cases of fracture. METHODS The primary stability-related parameters of a new uncemented/cemented screw were compared with those of conventional monocortical screw fixation in a burst fracture model in which strut graft and anterior overbridging instrumentation were used. The use of the new uncemented screw improved the range of motion (ROM) of the stabilized spine in flexion-extension by approximately 22%, in rotation by 20%, and in lateral bending by 15%. Additional cementation improved the ROM by approximately 41% in flexion-extension, 32% in rotation, and 30% in lateral bending compared with conventional monocortical screw fixation. CONCLUSIONS The new cannulated screw improves fixation strength and primary stability parameters. It is useful in the initial treatment of fractures in cases of poor bone quality and as a rescue device if previously inserted screws do not remain securely in place.
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Affiliation(s)
- Markus Schultheiss
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Ulm, Germany.
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Zelle B, Zeichen J, Pape HC, Weissenborn K, Krettek C. Upper sympathetic trunk lesion after video-assisted fracture stabilization of the thoracic spine: a case report. JOURNAL OF SPINAL DISORDERS & TECHNIQUES 2002; 15:502-6. [PMID: 12468978 DOI: 10.1097/00024720-200212000-00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This case report draws attention to the upper sympathetic trunk lesion as a complication of video-assisted thoracic spine surgery. A 39-year-old man developed an upper sympathetic trunk lesion after right-sided thoracoscopic fracture stabilization of T5 and T6. Dizziness and reduced perspiration persisted at the most recent follow-up 8 months after surgery. This rare complication can be overlooked and remain undiagnosed. Diagnosis is based on clinical symptoms and neurologic examination. There are no treatment options. Symptoms can be bothersome for the patient and may persist. In the upper thoracic spine, the course of the sympathetic trunk lies in close proximity of the vertebral bodies; thus, care must be taken to avoid it when resecting the posterior parts of the vertebral body.
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Affiliation(s)
- Boris Zelle
- Department of Trauma Surgery, Medical School of Hannover, Germany.
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Assaker R, Reyns N, Pertruzon B, Lejeune JP. Image-guided endoscopic spine surgery: Part II: clinical applications. Spine (Phila Pa 1976) 2001; 26:1711-8. [PMID: 11474359 DOI: 10.1097/00007632-200108010-00016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Endoscopic spinal procedures were performed under computed-tomography-based, image-guided assistance. OBJECTIVE To assess the clinical feasibility of applying a methodology that allows image-guided assistance in endoscopic spinal surgery. SUMMARY OF BACKGROUND DATA Endoscopic spinal procedures have become a part of the minimal invasive approaches to the spine. The main disadvantage of these techniques is the long learning curve and the lack of peroperative monitoring. Fluoroscopy does have disadvantages, such as positioning during surgery and the risk for radiation exposure. Fluoroscopy-based navigation has many advantages, however it is still based on preselected fluoroscopic images. There is no method that allows computed-tomography-based navigation in endoscopic conditions. METHODS Two patients have been operated on using endoscopic approaches assisted by computed-tomography-based navigational system. One had a thoracoscopic approach for median calcified disc herniation and another one had an endoscopic posterior approach for resection of a sacro-iliac osteophyte. For each patient, a frame of reference had been placed percutaneously and scanned. The computed tomography images were registered to the anatomy using the geometry of the frame as fiducials. Navigation through endoscopic approaches was possible in both cases. RESULTS In both cases navigation was reliable and a helpful monitoring to achieve the surgical goals through endoscopic approaches. CONCLUSIONS There are some factors that make endoscopic spine surgery a difficult start. Image-guided spine surgery is technically feasible and clinically applicable in endoscopic approaches.
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Affiliation(s)
- R Assaker
- Department of Neurosurgery, University Hospital, Lille, France.
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Affiliation(s)
- T J Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Abstract
The literature includes no studies on the use of video-assisted thoracoscopic surgery in the management of tuberculous spondylitis, and its role in the management of tuberculosis involving the thoracic spine remains unclear. The authors experience with 10 consecutive patients (six women, four men) who underwent video-assisted thoracoscopic surgery for the treatment of spinal tuberculosis involving levels from T5 to T11, from January 1996 to December 1997, was analyzed. Using the extended manipulating channel method (2.5-3.5 cm portal incisions), video-assisted thoracoscopic surgery was performed with a three-portal technique (seven patients) or a modified two-portal minithoracotomy technique that required a small incision for the thoracoscope and a larger incision, measuring 5 to 6 cm, for the procedures in three patients. All the patients were studied prospectively. The followup ranged from 17 to 42 months (mean, 24 months). Postoperative complications included one lung atelectasis. Pleural adhesions, owing to local inflammation or paravertebral abscess, were seen in four patients and one patient with severe pleurodesis needed an open technique for treatment. Postoperative air leaks were seen in four (40%) of 10 patients but all were transient. The average neurologic recovery was 1.1 grades on the Frankel's scale. The data from this series of patients with tuberculous spondylitis show that video-assisted thoracoscopic surgery has diagnostic and therapeutic roles in the management of tuberculous spondylitis. Technically, a combination of thoracoscopy and conventional spinal instruments to perform video-assisted thoracoscopic surgery through the extended manipulating channels, which were placed slightly more posterior than usual, was effective and safe.
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Affiliation(s)
- T J Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Liu HP, Yim AP, Wan J, Chen H, Wu YC, Liu YH, Lin PJ, Chang CH. Thoracoscopic removal of intrathoracic neurogenic tumors: a combined Chinese experience. Ann Surg 2000; 232:187-90. [PMID: 10903595 PMCID: PMC1421128 DOI: 10.1097/00000658-200008000-00006] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review the surgical and clinical results of minimally invasive resection of intrathoracic neurogenic tumors using a video-assisted thoracoscopic technique. SUMMARY BACKGROUND DATA Thoracoscopy has emerged as a possible means for diagnosing and managing various intrathoracic disorders. Benign intrathoracic tumors often are ideal lesions for resection using a video-assisted technique. The authors report on their combined experience with the thoracoscopic resection of 143 intrathoracic neurogenic tumors. METHODS Between March 1992 and February 1999, 143 patients with intrathoracic neurogenic tumors were diagnosed and underwent resection using video-assisted thoracoscopic techniques in three teaching centers. Case selection, surgical technique, and clinical results were reviewed. RESULTS The average age of the patients was 40.8 years; 57.3% were male. Thirty-eight patients (27%) had symptoms attributable to the masses. Seventy-two masses were neurofibromas, 33 were neurilemmomas, 7 were paragangliomas, and 31 were ganglioneuromas. All but seven tumors were located in the posterior mediastinum. The masses were on average 3.5 cm in greatest diameter. The mean surgical time was 40 minutes, and the average hospital stay was 4.1 days. There were no major postoperative complications or recurrences to date. Nine patients reported paresthesias over the chest wall during a mean follow-up of 29 months. CONCLUSIONS Resection of intrathoracic neurogenic tumors using a thoracoscopic technique based on standard surgical indications would seem to be appropriate. Most of these masses are benign and readily removed. For dumbbell tumors, a combined thoracic and neurosurgical approach is mandatory.
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Affiliation(s)
- H P Liu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
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