"Transforaminal thoracic interbody fusion" in the management of lower thoracic spine fracture dislocations: technical note.

STUDY

DESIGN

A case-control clinical study.

OBJECTIVES

To assess the usefulness and safety of a novel reconstructive procedure known as transforaminal thoracic interbody fusion (TTIF) in the treatment of lower thoracic spine fracture dislocations, and to compare its efficacy with posterior/anterior combined surgery (PACS).

SUMMARY OF BACKGROUND DATA: We developed a TTIF procedure for thoracic spine lesions, and obtained good clinical outcomes for degenerative disorders of the thoracic spine. However, the technique of TTIF in the lower thoracic spine fracture dislocation has never been reported.

METHODS

Seven consecutive patients with lower thoracic spine fracture dislocations underwent TTIF (6 males, 1 female; mean age, 32 y), and 16 consecutive patients with lower thoracic spine fracture dislocations underwent PACS (14 males, 2 females; mean age, 37 y). Surgical complications, clinical outcomes, and sagittal alignment were investigated. Bony fusion was assessed using plain and functional x-rays and computed tomography scans.

RESULTS

In the TTIF group and the PACS group, the mean operative times were 153 and 224 minutes, respectively, and the mean operative bleeding was 421 and 698 mL, respectively. All patients in the TTIF group were ambulatory within 2 days after surgery. Preoperative local sagittal alignments (kyphotic angles) were 22.9 and 22.5 degrees, respectively. Postoperative local sagittal alignments were 9.9 and 7.2 degrees, respectively. There were no instances of instrumentation failure or nonunion, and there were no serious complications such as neurological deficits in either group. In addition, a chest tube was necessary in 11 cases (69%) of PACS after thoracotomy, but was not required in any TTIF cases.

CONCLUSIONS

TTIF achieves posterior rigid fixation with instrumentation, and anterior column reconstruction by interbody fusion. This procedure also enables early postoperative ambulation without respiratory problems. TTIF can be a useful option for reconstructive surgery of the lower thoracic spine after fracture dislocations.