A.A. Grin, K.G. Zhestkov, V.Kh. Timerbaev, N.N. Nikolaev, M.S. Samarin, N.A, Polunina, A.K. Kaikov, M.M. Abakumov
(Sklifosovsky Research Institute of Emergency Care, Moscow)
There were two cases with uncomplicated trauma of the thoracic spine, operated with applying endoscopic modalities.
Female patient L, aged 41, was injured in a car crash. She occupied a passenger seat at that moment. Clinical and instrumental examinations, carried out in the resuscitation department, revealed severe associated trauma, a complicated fracture of the forth-tenth ribs on the right, right-side hemothorax, multilevel injury of the spine, a complicated compression-and-comminuted fracture of the L3 vertebra, an uncomplicated unstable compression fracture of the Th10 vertebra.
On admission one could watch inferior paraplegia with hypesthesia at the level of the L2 segment and impaired function of pelvic organs.
The right pleural cavity was drained. A complicated fracture of the L3 vertebra and overlapping of the vertebral canal by bone fragments (98%) demanded performing an urgent operation, i.e. decompressive laminectomy of L2-3 vertebrae, transpedicular anterior decompression of the vertebral canal, revision of the horseís tail roots, suturing of dura ruptures, transpedicular spondylodesis with the Diapason 1.2-4 titanium system.
The patientís state improved a month after admission and she was subjected to little-invasive endoscopic reclination of the Th10 vertebra and stabilization of Th9-Th11 vertebrae with the titanium Z-plate from 4 thoracoports. It was done with the purpose of reducing a volume of surgical trauma. The operation duration and blood loss were 185 min and 150 ml respectively. Sutures were removed on the eighth day. There were no complications.
Anterior corporodesis of L2-4 with an autobone was made two weeks later. On discharge restoration of movements in lower extremities was characterized by a score of 1-2.
Male patient B., aged 30, had trauma, caused by falling down from a motorcycle. On admission the diagnosis was as follows: associated trauma, an uncomplicated unstable compression-and-comminuted fracture of the Th11 vertebra, a fracture of transverse processes of Th8-10 vertebrae and the spinous process of the Th10 vertebra, an uncomplicated fracture of the 11th vertebra on the left.
Endoscopic stabilization of Th9-12 vertebrae with the titanium Z-plate was performed from 4 thoracoports. The operation duration and blood loss were 220 min and 130 ml respectively. Sutures were removed on the ninth day. There were no complications.
Conclusions: Thoracoscopic stabilization of the spine can be used as a little-invasive method for treatment of cases with uncomplicated unstable trauma of the spine. It is necessary to carry out further accumulation of experience and to determine a place of endoscopic spondylodesis in surgery of traumatic lesions of the spine.