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Three-dimensional thoracoscopic vertebral body replacement at the thoracolumbar junction

Dreidimensionaler thorakoskopischer Wirbelkörperersatz am thorakolumbalen Übergang

  • Surgical Techniques
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

An Erratum to this article was published on 14 September 2018

This article has been updated

Abstract

Objective

The aim is to stabilize the thoracolumbar spine with a thoracoscopically implanted vertebral body replacement (VBR). To improve intraoperative depth perception and orientation, implantation is performed under three-dimensional (3D) thoracoscopic vision.

Indications

Vertebral burst fractures at the thoracolumbar junction (A4 AOSpine classification), pseudarthrosis, and posttraumatic instability with increasing kyphosis.

Contraindications

Severe pulmonary dysfunctions, pulmonary or thoracic infections, previous thoracic surgery, and pulmonary adhesions.

Surgical technique

The patient is lying in a right lateral decubitus position. Localization of the fractured vertebra. Minimally invasive transthoracic approach. Perform single lung ventilation and insert the 3D thoracoscope two intercostal spaces above the working portal. Utilization of special binocular glasses for 3D vision of the operation field and secure resection of the fractured vertebra.

Measurement of the bony defect and insertion of the expandable cage. Control of correct cage position under fluoroscopy. Insertion of a chest tube and inflate the left lung.

Postoperative management

Chest × ray

Remove chest tube when output is <500 ml/24 h

Early mobilization on the ward

6 weeks no weight-bearing >5 kg

Results

Between 2012 and 2017, 12 patients received a VBR under 3D thoracoscopic vision. After a mean follow up of 26 months, no cage dislocation was noticed and all patients recovered from the initial back pain. Complications were notable in two cases (17%) with a small pneumothorax after removal of the chest tube and postoperative pneumonia in one patient (8%). All responded to conservative treatment. Revision surgery was not necessary.

Zusammenfassung

Operationsziel

Wiederherstellung einer belastungsstabilen Wirbelsäule durch thorakoskopische Implantation eines Wirbelkörperersatzes. Zur Verbesserung der intraoperativen Tiefenwahrnehmung und Orientierung erfolgt die Implantation unter 3‑dimensionaler (3-D) Thorakoskopie.

Indikationen

Thorakolumbale Berstungsfrakturen (A4 nach AOSpine-Klassifikation), Pseudarthrose, posttraumatische Instabilität mit zunehmender Kyphose

Kontraindikationen

Schwere pulmonale Dysfunktion, pulmonale oder thorakale Infektionen, thorakale Voroperationen, pulmonale Adhäsionen

Operationstechnik

Lagerung in Rechtsseitenlage auf der Vakuummatratze. Lokalisation des frakturierten Wirbelkörpers. Minimalinvasiver transthorakaler Zugang. Einlungenventilation und Einbringen des Thorakoskops 2 Interkostalräume kranial des Arbeitsportals. Nach Aufsetzen der 3‑D-Brillen entsteht ein 3‑D-Bild des Operationsgebiets und eine sichere Resektion des frakturierten Wirbelkörpers ist möglich. Ausmessen des knöchernen Defekts und Einsetzen des expandierbaren Cage. Lagekontrolle unter Bildwandler. Einlage einer Thoraxdrainage und Entfalten der linken Lunge.

Weiterbehandlung

Röntgenuntersuchung des Thorax a.-p.; Entfernung der Thoraxdrainage bei Fördermenge <500 ml/24 h; frühzeitige Mobilisation auf Stationsebene; 6 Wochen postoperativ kein Heben und Tragen >5 kg

Ergebnisse

Zwischen 2012 und 2017 wurde bei 12 Patienten ein Wirbelkörperersatz in 3‑D-thorakoskopischer Technik durchgeführt. Während einer durchschnittlichen Follow-up-Zeit von 26 Monaten wurde keine Implantatdislokation festgestellt. Alle Patienten beschrieben eine wesentliche Linderung der initialen Rückenschmerzen. Als Komplikation wurde bei 2 Patienten (17 %) ein schmaler Pneumothorax nach Entfernung der Thoraxdrainage festgestellt, bei einem Patienten (8 %) eine Pneumonie. Alle Komplikationen wurden erfolgreich konservativ behandelt. Revisionsoperationen waren nicht erforderlich.

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Change history

  • 14 September 2018

    Erratum to:

    Oper Orthop Traumatol 2018

    https://doi.org/10.1007/s00064-018-0559-3

    The article was wrongly published under the article type “Review”. Please note that the article is an “Original Paper”.

    The publisher apologizes to authors and …

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    C. Jacobs, M. M. Plöger, S. Scheidt, P. P. Roessler, S. Koob, K. Kabir, D. C. Wirtz, C. Burger & R. Pflugmacher

  2. Poliklinik für Kieferorthopädie, Universitätsklinikum Jena, Jena, Germany

    C. Jacobs

  3. Klinik für Unfallchirurgie und Orthopädie, Luisenhospital Aachen, Aachen, Germany

    F. Trommer

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Correspondence to C. Jacobs.

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Conflict of interest

C. Jacobs, M.M. Plöger, S. Scheidt, P.P. Roessler, S. Koob, K. Kabir, C. Jacobs, D.C. Wirtz, C. Burger, R. Pflugmacher, and F. Trommer declare that they have no competing interests.

Data for this retrospective study were gathered after approval by the appropriate ethics commission of the University of Bonn (IRB 193/17) and in accordance with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

Editor

M. Mayer, München

Illustrator

J. Kühn, Heuchelheim-Klingen

C. Jacobs and M.M. Plöger contributed equally to this manuscript.

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Jacobs, C., Plöger, M.M., Scheidt, S. et al. Three-dimensional thoracoscopic vertebral body replacement at the thoracolumbar junction. Oper Orthop Traumatol 30, 369–378 (2018). https://doi.org/10.1007/s00064-018-0559-3

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