Computer-aided discectomy and corpectomy in anterior reconstruction of the injured thoracolumbar spine. A prospective, controlled clinical trial

• Published in: Der Unfallchirurg Vol. 111; no. 11; pp. 878 - 885
• Main Authors: Blattert, T R, Springwald, J, Glasmacher, S, Siekmann, H, Josten, C
• Format: Journal Article
• Language: German
• Published: Germany 01.11.2008
• Subjects: Adult; Diskectomy - methods; Female; Humans; Lumbar Vertebrae - injuries; Lumbar Vertebrae - surgery; Male; Middle Aged; Spinal Fractures - diagnosis; Spinal Fractures - surgery; Surgery, Computer-Assisted - methods; Treatment Outcome; Young Adult
• ISSN: 0177-5537
• DOI: 10.1007/s00113-008-1480-2

In anterior reconstruction of the unstable thoracolumbar spine, discectomy and corpectomy are technically demanding steps requiring maximal surgical precision. This study investigated the feasibility of computer-aided guidance for discectomy and corpectomy. It also analysed the precision, advantages, and disadvantages of the procedure. Vertebral body fractures of the non-osteoporotic thoracolumbar spine addressed by discectomy/corpectomy and subsequent implant interposition (cage, tricortical strut graft) for anterior reconstruction were included. All surgical steps were done under endoscopic assistance. In the trial group, discectomy and corpectomy were performed with computer-aided guidance; in the control group, no computer navigation was used. The time required for surgery was noted. To assess surgical precision, decentralization of the implant in the frontal plane was measured in postoperative x-rays and computed tomography. Additionally, parallel alignment of vertebral body end plates with the implant was evaluated. The trial group (TG) consisted of 16 patients, and the control group (CG) of 10 patients. Fractures were localized between T10 and L1 in TG, and between T9 and L1 in CG. Operating time was significantly shorter in CG: 104+/-28 min compared with 229+/-64 min in TG (p<0.0005). In contrast, data on surgical precision showed no statistically significant differences between the 2 groups for either decentralization or parallel endplate alignment of implants. Remarkably, for CG we noted 2 cases of cage subsidence into an adjacent end plate, whereas for TG this was noted in only 1 case. However, this difference was not statistically significant. Computer-aided guidance for anterior reconstruction of the thoracolumbar spine is a technically feasible option that may help in performing discectomy and corpectomy. However, this technique significantly prolongs the operating time. There were no differences in the precision of implant positioning between the groups. However, during discectomy the use of computer navigation may possibly add to the protection of adjacent end plates.