Thoracoscopic Vertebral Body Replacement of Burst Fractures in the Thoracolumbar Spine with a Distractable Titanium Cage
Authors: Wutte Christof , Ortmaier Reinhold , Resch Herbert , Plachel Fabian , Bogner Robert 
Published: April 2016

Introduction

The treatment of burst fractures in the thoracolumbar spine is controversially discussed. Therapeutic options reach from conservative measures up to the meanwhile established approach through dorsoventral stabilization. Thoracoscopy-assisted operation methods have been applied to restore the anterior column in the ventral spine for a couple of years. This approach helps to avoid invasive thoraco- and laparotomies and prolonged healing periods. These procedures are associated with certain complications such as chronic pain syndrome in over 50% of affected individuals. The Hydrolift (B. Braun Aesculap) is an infinitely variable, expandable vertebral body replacement available for thoracoscopy-assisted implantation. The aim of this study was to evaluate the clinical and radiological outcome, patients' reintegration in the working environment and possible restrictions during athletic and daily-live activities.

Materials and Methods

We performed a retrospective analysis including 30 patients (m:f = 24:6, average age: 56 years) with fractures of the vertebral bodies Th12 and L1 (3 A3.2, 23 A3.3, 4 B2.3), that have been treated with an infinitely variable, expandable vertebral body replacement (Hydrolift, B. Braun Aesculap) and an axis-stable plate (MACS, B. Braun Aesculap) in the Department of Traumatology of the University Hospital Salzburg, Austria between 03/2009 and 09/2013. A clinical follow-up, an assessment of the impairment through questionnaires (Oswestry Disability Index and VAS Spine) and a radiological evaluation of the position and osseous integration of the cage through CT have been collected after an average of 22 (18–47) months.

Results

11 out of 30 patients have the same quality of life as prior to the injury, 13 have low-grade restrictions. After an average recovery period of 5 months, 56,7% of the patients are 100% reintegrated in their previous working life, 36,7% can continue working up to 75%. 1 Patient has changed his profession to a physically less challenging field, 1 patient is unable to work. 5 patients were retired prior to the accident. The outcome of the Oswestry Disability Index shows a low-grade impairment in everyday life with an average of 12,9% (0–40%). The analysis of the VAS Spine shows scores between 47,4% and 96,0%, with an average of 80,5%. A correction of 11,4° could be achieved after dorsoventral stabilization. The correction loss after reconstruction of the ventral spine with Hydrolift amounts to 1,8°. An osseous integration of the implants was observed in 96,7% of the patients. Two cases of a mild dislocation of the Hydrolift into the adjacent vertebral body took place, without any clinical relevance.

Conclusion

A stable treatment of burst fractures in the thoracolumbar spine can be achieved through a ventral spondylodesis with the Hydrolift and axis-stable MACS plate. The thoracoscopy-assisted operative treatment with Hydrolift is a successful method, due to stability, low additional morbidity, a high reintegration rate in the patients working environment (96%) and a high continuation of their familiar athletic activities.