gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

360-degree thoracic osteosynthesis via a postero-lateral transpedicular approach in high-risk patients

Meeting Abstract

  • S. Eicker - Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf
  • D. Hänggi - Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf
  • H.J. Steiger - Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf
  • J.F. Cornelius - Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 057

DOI: 10.3205/11dgnc278, URN: urn:nbn:de:0183-11dgnc2787

Published: April 28, 2011

© 2011 Eicker et al.
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Outline

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Objective: Patients with cardiopulmonary disease have a high morbidity after thoracic spine surgery via a transthoracic approach. We present a postero-lateral transpedicular approach, which allows one to perform a 360° fusion of the thoracic spine. By avoiding the transthoracic route, this technique is thought to reduce cardiopulmonary complications in high-risk patients.

Methods: The procedure was carried out in four patients with osteoporotic, metastatic and tuberculotic fractures of the thoracic spine, respectively. All patients presented with spinal cord compression. Vertebral body and pedicle involvement was detected in each case. Patients were instrumented from posterior with a screw-rod-system. Then spinal cord decompression was achieved by laminectomy, facetectomy with partial costotransversectomy and corpectomy. After rhizotomy, the vertebral body was replaced by one or two custom-fit implants (Harms cage) via a transpedicular route from one or both sides.

Results: The procedure was successfully performed in four high-risk patients (one male and three female with a mean age 68.25 years ± 13.15). Preoperatively, all patients presented with thoracic and back pain. One patient was admitted with a paraparesis (Frankel grade C). On CT and MRI there was a kyphosis and the spinal canal diameter was reduced by an average of 35% at the level of injury. Two patients underwent surgery at one level (Th 2; Th11) and two patients at two levels (Th 3/4; Th 6/7). The implants were introduced monoportally (three patients, each with one implant) or biportally (one patient with two implants). There were no post-operative complications. In all cases, neurological symptoms moderately improved. In the short-term follow-up after 3.5 months (± 2.65), all patients were pain-free. Radiologically, there was no significant influence on preoperative kyphosis and no implant dislocation was detected.

Conclusions: The presented postero-lateral transpedicular approach allows for a circumferential fusion. It was safe and efficient with promising short-term results. However, regarding biomechanic efficacy and long-term outcome as compared to the transthoracic technique, a larger patient cohort with a longer follow-up is necessary.