C. Doria, A. Zachos, F. Muresu and P. Tranquilli Leali
Introduction: In our clinic for several years we are pursuing the concept of mini-invasive surgery applied to the spine. Increasingly we have to our attention patients with comorbidities (figure 1) and for this reason could not face a major surgery. In this work we analyze various patients who suffered an osteoporotic vertebral fracture. The fractures on CT and MRI study, presented a minimal back protrusion of the wall with no images related to compression of the structures (figure 2a, 2b, 2c), but presented deformities,like kyphosis. The deformities in the past would certainly have required anterior surgery and corpectomy with placement of a mesh and interbody stabilization. This method provides access to trans-abdominal peritoneal or retro peritoneal and often requires the collaboration of general and vascular surgeon due to the presence of abdominal viscera and major vessels.
Materials and methods: From January 2008 to August 2011, we treated 26 patients, 10 males and 16 females with a mean age 66 years. Most of them presented comorbidities. We decided to use a minimally invasive technique that allowed us to avoid the anterior approach, however, allowing us to attack the affected vertebrae through a less traumatic way possible. The surgery was performed by 2 surgical approaches performed in the same operative session. The first provided a lateral position with incision of about 4 cm. The exhibition allows direct visualization of the lateral side facilitating the disc discectomy, corpectomy, and the placement of a prosthetic vertebral body expansion and bone grafting. Through this technique it is possible to remove the fractured vertebral body and restore the mechanical support of the anterior column. The second half provided a hand lying prone and the insertion of pedicle screws cemented in the vertebral bodies adjacent to the fractured vertebra solidarity by means of two rods. The degree of kyphosis, construct height and the subsidence of the cage in relation to the vertebral endplates were measured preoperatively, early postoperatively, and at the latest follow-up.
Results: No intraoperative complications were observed. Faster functional recovery is observed and load was granted from the fifth to ninth day. Pain relief with reduction of VAS values (pre-op 9, post-op 5) and ODI (86% pre-op, post-op 38%).
Conclusions: The advent of minimally invasive surgery has allowed us to perform surgeries, such as the vertebral corpectomy, with minimal access, low blood loss, allowing rapid functional recovery with reduced length of stay.