Video-assisted treatment of thoracolumbar junction fractures using a specific distractor for reduction: prospective study of 50 cases

Posterior instrumentation allows good osteosynthesis for thoracolumbar junction fractures. However, in approximately 20% of cases, anterior bone defects may persist, leading to pseudoarthrosis and loss of reduction. Anterior approaches can circumvent this drawback, but they are considered aggressive with a high rate of complications. The advent of the endoscopic mini-invasive techniques has led to a reduction in the number of complications while maintaining the same consolidation rate. Nevertheless, poor restitution of anatomic curves is a reproach for this technique. This prospective study reports clinical and radiological result of 50 patients (19 women and 31 men) operated between April 2000 and March 2006 with a video-assisted anterior approach using an endodistractor for reduction and consequent insertion of the implant. There were A3 (n = 44), A2 (n = 2), A1 (n = 3) and C1 (n = 1) fractures (Magerl classification). The specific system for fracture reduction was used in the last 39 cases of this series. A Pyramesh cage (Medtronic, Memphis, USA) was used in 15 patients, a peek cage (Creaspine, Bordeaux, France) in 30 patients and a tricortical graft in 5 patients. Standard X-rays and CT scan were performed pre-operatively. Kyphosis, and angulations were measured pre-, per- and post-operatively. Mean immediate postoperative gain in localized kyphosis was 12.18° and mean gain at last follow-up was 11.71°. Mean immediate postoperative gain in RA was 13.24° and remained identical at last follow-up. Five patients had a transient pulmonary atelectasia and there was one pulmonary infection. No neurological complication occurred. Fracture reduction is comparable to the best thoracotomy series while limiting approach-related complications.