Minimally Invasive Vertebral Replacement with Cages in Thoracic and Lumbar Spine

Abstract

Patients and Methods: Anterior reconstruction of the thoracic and lumbar spine was performed using Synex™-cages for vertebral body replacement implanted via open but minimally invasive access in 57 patients with trauma (n = 48), metastasis (n = 6), pseudarthrosis (n = 2), and spondylodiscitis (n = 1).

Results: No case had to be changed into an open procedure. The upper thoracic spine was approached by a right-sided (n = 10), the thoracolumbar junction by a left-sided (n = 37) mini-thoracotomy, and the lumbar spine by a left-sided mini-retroperitoneal approach (n = 10). The overall mean operating time was 150 min (range 40–325 min) but varied depending on the spine pathology and the magnitude of the intervention to the anterior part of the spine. There were neither visceral/vascular complications nor other intra- or postoperative complications related to the minimal access in particular. No intercostal neuralgias, no post-thoracotomy pain syndromes and no superficial or deep wound infections occurred. One patient with metastatic destruction of the vertebra died intraoperatively due to a thromboembolic complication caused by his underlying disease. Two cases of pseudo-obstruction were treated conservatively.

Conclusion: In this study, we describe the use of a new vertebral body replacement for reconstruction of the thoracic and lumbar spine which had been implanted by minimal-access technology.