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Trans-Thoracic Extra-Pleural Percutaneous Spinal Fixation-A Technical Note
Shyam S Krishnan1, Pulak Nigam1, Madabhushi C Vasudevan1
1Post Graduate Institute of Neurological Surgery, Achantha Lakshmipathi Neurosurgical Centre, Voluntary Health Services, Chennai, Tamil Nadu, India.
Study Design:
Cross-sectional analysis of defined parameters of patients who underwent the presented technique. Patients undergoing thoracic spine fixation for various pathologies.
Objective:
This technique attempts to limit the incision size in extrapleural thoracotomy for multi-level spinal fixation.
Summary Of Background Data:
Dorsal spine is traditionally approached by either transpleural or extrapleural approach. The extrapleural approach carries a limitation of being restricted in number of levels it can address. By incrementally modifying the present technique, we were able to employ the approach in greater number of levels with lesser morbidities.
Method:
Classical extrapleural thoracotomy approach is employed with incision size limited to the levels of pathology (~5 cm). Thereafter, proper exposure using Kittner dissection and defining of screw entry points follows. Stab incision is made and screws placed percutaneously through a K-wire-defined trajectory.
Results:
Eighteen patients underwent fixation through this technique, of which 11 were infectious, four were traumatic, and the rest were neoplastic in pathology. None except three patients had ICU stay of more than 1 day. All patients had a pain score of 6 or lower except for two.
Conclusion:
Combining the technique of percutaneous screw placement with traditional extrapleural thoracotomy reduces the size of the incision, tissue damage, and morbidity while reducing the cost and duration of hospitalization without comprising the extent of pathology that can be dealt with.
