The preliminary results of minimally invasive lateral lumbar interbody fusion combined with posterior short-segment instrumentation for thoracolumbar fractures

English Keywords:Thoracolumbar fractures  Lateral interbody fusion  Minimally invasive spine surgery  Short-segment instrumentation

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical outcomes of minimally invasive lateral lumbar interbody fusion(LLIF) combined with posterior short-segment instrumentation for thoracolumbar fractures. Methods: From Octomber 2009 to September 2012, twelve patients with thoracolumbar fractures who met the inclusion criteria were treated with posterior short-segment pedicle instrumentation combined with delayed minimally invasive LLIF. There were 10 males and 2 females with a mean age of 33±9.4 years(21-47 years). All the patients underwent posterior short-segment pedicle instrumentation as the initial treatment. Minimally invasive LLIF was performed within two weeks after the posterior procedure, under the assistance of self-designed working-tunnel. The levels of LLIF included T11/12 in 4 patients, T12/L1 in 5 and L1/2 in 3. The evaluation index included average operation time, average blood loss and complication associated with the surgery. ASIA impairment scale(2011) and Cobb angle were used to evaluated the neurological function and the loss of correction preoperatively, postoperatively and at final follow-up, respectively. The status of fusion was evaluated according to Suk′s criteria at final follow-up. Results: All the patients tolerated the operation well. The mean operation time and blood loss of the posterior procedure was 125.8±29 minutes and 460±88.1ml, respectively, while 127.1±21.7 minutes and 185.8±62.3ml, respectively for the minimally invasive LLIF procedure. Hemopneumothorax was noted in 1 case after the minimally invasive LLIF procedure. One patient presented with neurological deficit after LLIF procedure. The mean follow-up period was 12.75±4.6 months. The mean Cobb angle improved from 31°±8.7° preoperatively to 5.1°±3.5° postoperatively. At final follow-up a mean of 4.3°±2.1° of loss of correction was noted. Solid fusion was achieved in 8 patients(66.7%) and probable fusion was in 4 patients(33.3%). Five patients with incomplete spinal cord injury achieved at least one grade of neurological function improvement, others had no change. No implant failure was noted. Conclusions: Posterior short-segment pedicle instrumentation combined with minimally invasive LLIF is effective for indicative thoracolumbar fractures, if it can be used for an alternative or complementary treatment for conventional wide-open combined anterior and posterior approaches, needs more cases and longer observation.