Anterior corpectomy via the mini-open, extreme lateral, transpsoas approach combined with short-segment posterior fixation for single-level traumatic lumbar burst fractures: analysis of health-related quality of life outcomes and patient satisfaction

• Published in: Journal of neurosurgery. Spine Vol. 24; no. 1; p. 60
• Main Authors: Theologis, Alexander A, Tabaraee, Ehsan, Toogood, Paul, Kennedy, Abbey, Birk, Harjus, McClellan, R Trigg, Pekmezci, Murat
• Format: Journal Article
• Language: English
• Published: United States 01.01.2016
• Subjects: Adult; Aged; Female; Humans; Lumbar Vertebrae - surgery; Lumbosacral Region - surgery; Male; Middle Aged; Patient Satisfaction; Quality of Life; Retrospective Studies; Spinal Fractures - surgery; Spinal Fusion - methods; Thoracic Vertebrae - surgery; Treatment Outcome; Young Adult; lumbar; trauma; extreme lateral; minimally invasive surgery; ODI = Oswestry Disability Index; MIS = minimally invasive surgery; burst fractures; TLICS = Thoracolumbar Injury and Classification Score; clinical outcomes; MCS = mental component score; PCS = physical component score; SF-12 = 12-Item Short Form Health Survey; corpectomy; transpsoas approach; ASA = American Society of Anesthesiologists
• ISSN: 1547-5646
• DOI: 10.3171/2015.4.SPINE14944

The authors present clinical outcome data and satisfaction of patients who underwent minimally invasive vertebral body corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach and posterior short-segment instrumentation for lumbar burst fractures. Patients with unstable lumbar burst fractures who underwent corpectomy and anterior column reconstruction via a mini-open, extreme lateral, transpsoas approach with short-segment posterior fixation were reviewed retrospectively. Demographic information, operative parameters, perioperative radiographic measurements, and complications were analyzed. Patient-reported outcome instruments (Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12]) and an anterior scar-specific patient satisfaction questionnaire were recorded at the latest follow-up. Twelve patients (7 men, 5 women, average age 42 years, range 22-68 years) met the inclusion criteria. Lumbar corpectomies with anterior column support were performed (L-1, n = 8; L-2, n = 2; L-3, n = 2) and supplemented with short-segment posterior instrumentation (4 open, 8 percutaneous). Four patients had preoperative neurological deficits, all of which improved after surgery. No new neurological complications were noted. The anterior incision on average was 6.4 cm (range 5-8 cm) in length, caused mild pain and disability, and was aesthetically acceptable to the large majority of patients. Three patients required chest tube placement for pleural violation, and 1 patient required reoperation for cage subsidence/hardware failure. Average clinical follow-up was 38 months (range 16-68 months), and average radiographic follow-up was 37 months (range 6-68 months). Preoperative lumbar lordosis and focal lordosis were significantly improved/maintained after surgery. Patients were satisfied with their outcomes, had minimal/moderate disability (average ODI score 20, range 0-52), and had good physical (SF-12 physical component score 41.7% ± 10.4%) and mental health outcomes (SF-12 mental component score 50.2% ± 11.6%) after surgery. Anterior corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach supplemented by short-segment posterior instrumentation is a safe, effective alternative to conventional approaches in the treatment of single-level unstable burst fractures and is associated with excellent functional outcomes and patient satisfaction.