• Jian Zhao, Klaus-Dieter Schaser, and Feng Zhang.
• Spinal Center, Affiliated Hospital of Nantong University, Nantong, China. drzhaojian@vip.sina.com
• Orthop Surg. 2010 May 1;2(2):100-5.

ObjectiveTo evaluate the surgical techniques and outcomes of revision surgery for compromised posterior stabilization or insufficient neurological decompression using anterior mini-open approach and expandable cage.MethodsFrom August 2005 to June 2008, a total of 235 patients were operated on in our center for thoracolumbar fractures with dorsal transpedicular stabilization. Twenty-six of these patients underwent revision surgery, the main reasons being back pain and stagnant neurological recovery. The surgical procedure comprised a single-level thoracolumbar corpectomy and/or canal clearance, followed by an expandable cage reconstruction. The average interval between primary and revision surgery was 5 months (range, 3-11 months). A transthoracic (n= 11) or transthoracic transdiaphragmatic (n= 15) mini-open approach was conducted using a table-mounted retractor.ResultsThe operating time averaged 105 min (range, 95-135 min) for the transthoracic approach and 152 min (range, 120-190 min) for the transthoracic plus transdiaphragmatic approach. The overall mean blood loss was 780 ml (range, 550-1700 ml). Over time, the pre-operative neurological deficit improved in 6/7 patients by at least one Frankel/American Spinal Injury Association (ASIA) grade. On a visual analogue scale (VAS) from 0 to 10, the mean local thoracolumbar back pain was relieved significantly from 6.8 before operation to 3.8 at 3 months, 2.4 at 6 months, and 1.5 at 12 months postoperatively. None of the patients developed intercostal neuralgia or post-thoracotomy pain syndromes.ConclusionFor patients with compromised stabilization or insufficient neurological decompression after primary dorsal transpedicular stabilization for thoracolumbar fracture, anterior revision surgery can produce good results. The mini-open anterior approach for corpectomy in the thoracolumbar spine is safe, reliable, and economical. The expandable cage is an excellent alternative for anterior reconstruction.© 2010 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

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