Thoracoscopic repair of thoracic spine trauma

Modern concepts of treating thoracic and lumbar spinal trauma are based on posterior transpedicular fixation techniques which confer angular stability and instrument only a few levels of the spine. In addition, to prevent secondary losses in postoperative reduction of kyphotic deformities, transpedicular resection of torn discs, and inter- and intracorporeal bone grafting are included in the repair procedures for the entire damaged motion segment. However, due to the small size of the pedicles, a transpedicular approach to the injured vertebral body is not possible in the upper thoracic spine. Patients whose thoracic spine trauma is not serious enough to require ventral instrumentation through open thoracotomy, but who present with an unstable vertebral fracture, may profit from additional ventral bone grafting to stabilize the fracture. The present study examined the feasibility of thoracoscopic ventral bone grafting in seven patients with unstable fractures of the upper thoracic spine. For primary repair, we stabilized the fracture by using posterior transpedicular screw systems (rods or plates). Simultaneously, spongiosa was harvested from the posterior iliac crest and deepfrozen. Repair was completed a few days later via a ventral thoracoscopic approach. The main location of the ventral osseous defect was identified by intraoperative radiology. After mechanical removal of destroyed connective tissue and disc material, fusion was performed using the previously harvested spongiosa, which was placed into the intervertebral disc space and the anterior osseous defect. Our results show thoracoscopic bone grafting to be technically possible and associated with low morbidity, with a potential of yielding satisfactory long-term results.