Minimally Invasive Posterior Thoracic Fusion
This is a nine-part series about minimally invasive spine surgery from the American Association of Neurological Surgeons (AANS). The links below will help you easily navigate through this article series:
- Minimally Invasive Spine Surgery
- Minimally Invasive Fusion Procedures
- Minimally Invasive Lateral Interbody Fusion (XLIF and DLIF)
- Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF)
- Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)
- Minimally Invasive Posterior Thoracic Fusion
- Microdiscectomy and Microendoscopic Laminectomy
- Minimally Invasive Cervical Foraminotomy and Minimally Invasive X-STOP IPD Procedure
- Vertebroplasty and Kyphoplasty
A thoracic spinal fusion may be indicated for the surgical treatment of a wide range of conditions, including trauma, deformity, tumor, and infection. Conventional open surgical procedures for treatment of thoracic spine disease can be associated with significant approach-related morbidity. Recent advances in technology have led to the development of posterior minimally invasive surgical approaches for thoracic fusion.
In a posterior thoracic fusion, the surgical approach to the spine is from the back through a midline incision. Special retractors are utilized, in addition to fluoroscopy, which provides intraoperative x-ray images of the spine. Monitoring equipment is used to determine the placement of the instruments in relationship to the spinal nerves.
At present, thoracic MIS techniques are primarily used for stabilizing traumatic injuries, although some surgeons may use these techniques for treatment of tumors, infections, or degenerative disc disease. These procedures typically take about 3 to 3 ½ hours to perform, although with more complex spinal disorders, longer procedures may be necessary.
Outcome
A large study of 104 spine trauma patients who underwent MIS transmuscular pedicle screw fixation of the thoracic and lumbar spine yielded the following results. Overall, 87% of screws were judged to be good, 10% were judged to be acceptable, and 3% were judged to be unacceptable.
Immediate surgical revision, which was always performed through MIS techniques, was necessary in nine patients for pedicle screw repositioning and in two patients for incomplete tightening of anchor bolts. In the entire patient group, two patients with an unacceptable screw position had new radicular pain that resolved completely after screw repositioning, and two patients had delayed wound healing. No patients experienced new neurological deficits.
American Association of Neurological Surgeons
Neurosurgerytoday.org
Minimally Invasive Spine Surgery, January 2009
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