V.D. Usikov, E.M. Fadeev, D.A. Ptashnikov, Sh.Sh. Magomedov
(Vreden Research Institute of Traumatology and Orthopedics, Saint Petersburg)
We operated 1600 cases with trauma of the thoracic spine during almost 20 years of existence of the Spinal Pathology Department. Operations on a ventral segment of the spine were made in more than a half of patients. These interventions demand performing conventional thoracotomy, which is characterized by extensive section of soft tissues, dissection of big groups of muscles, resection of one or several ribs. It is accompanied by considerable blood loss and marked pain syndrome and, as a result, long-tern postoperative rehabilitation of patients.
In order to reduce a traumatic effect of ventral interventions, in 2006 we started to make video-assisted thoracoscopic interventions, using a standard videoendoscopic complex (Storz company) and instruments, manufactured by Aesculap. We applied a mini-approach (4-5 cm), performed down an intercostals space, and 2 thoracoports with a diameter of up to 15 cm for introduction of a thoracoscope and a suction device.
We operated 46 cases with complicated compression-comminuted fractures of the thoracolumbar spine. Casualties underwent ventral decompressive-stabilizing interventions, using a mini-approach and endoscopic technique. Interventions were often limited to removal of an injured disc and subsequent corporodesis with an autobone or a cage. In case of necessity we performed decompression of a dural sac, resecting a posterior third of an injured body and an adjacent disc, as well as deformity correction by an internal reclinator.
Operation duration varied from 1 hour 40 minutes up to two hours and a half. Mean blood loss and a period of stay in hospital were 250-300 ml and 11.4 days respevtively. There was considerable reduction of pain syndrome, which decreased necessity of applying anesthetics by 3 days. As a result, the patients began to stand and walk on the forth day after operation. There were no complications.
Thus, video-assisted operations have several advantages over conventional thoracotomy and thoracoscopic interventions. On the one hand, endoscopic technique allows to achieve the following results:
On the other hand, a mini-approach causes no prolongation of an operation, which is typical of endoscopic interventions, and gives a chance:
Thus, application of endoscopic technique in surgery of the thoracic spine is a prospective trend, which demands further study and improvement.