[Minimal invasive circumferential fusion in the management of kyphotic thoracolumbar lesions: Technical note]

Management of spinal kyphotic deformities remains challenging in order to achieve a complete correction of the deformity, stabilize the spine and restore a satisfactory sagittal alignment. The aim of this study was to report the results of a technique combining, during the same operative session: a percutaneous osteosynthesis (with or without decompression) and a minimal invasive corpectomy using an anterior approach.

Twelve patients (mean age 54 years old) were included in this single center retrospective study. Kyphotic deformity was related to a trauma in 9 cases, to a tumor in 2 cases and was infectious in the last case. The level involved was L1 in 7 cases, T12 in 3 cases, T10 and L4 in 1 case each. First step of the surgical strategy was a routine posterior percutaneous osteosynthesis. In 5 cases, a complementary minimal invasive decompression was performed using tubular retractors. During the second step, an anterior corpectomy was performed and the vertebral reconstruction was done using telescopic vertebral body prosthesis. Once the last correction was achieved, final locking of the posterior instrumentation was performed.

In the entire series, a short construct was done in 2 cases and a long construct was decided for the 10 other cases depending on the lesion. Mean surgical time was 246 min [173-375] and postoperative blood transfusion was not necessary. Patients were discharged from the hospital on average at day 8 [4-25] according to associated lesions. Based on radiographic analyses, a significant restoration of the vertebral kyphosis (average 17°, P<0.001) and vertebral body height (27% on average, P<0.001) were obtained.

Combination of these two minimal invasive techniques allows a circumferential spinal fixation with a low rate of complications and a satisfactory restoration of local sagittal deformity. This strategy is, in our experience, a valuable alternative to conventional techniques. Further studies with a longer follow-up will therefore needed in order to confirm these results.