Computer-assisted anterior reconstruction surgery for a thoracolumbar fracture: a case report
Ho-Yeon Lee1, Sang-Ho Lee1, Sang-Ki Chung1, Song-Woo Shin1, Sang-Rak Lim2, Richard Kaul3
1Departments of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
2Departments of General Surgery, Wooridul Spine Hospital, Seoul, Korea
3Department of Neurosurgery, Pompton Plains Surgical Center, New Jersey, USA
Keywords: Bone screws; lumbar vertebrae/surgery/radiography; spinal fusion/instrumentation; stereotaxic techniques; therapy, computer-assisted; tomography, X-ray computed.
Abstract
Application of the computer-assisted navigation system to the anterior approach is considered difficult due to smooth topography of the anterior vertebrae. In this case report, we presented our modification of computer-assisted image-guided navigation to perform anterior thoracolumbar reconstruction in a 50-year-old female patient with an osteoporotic compression fracture without cord compression at the L1-2 level. In the right lateral decubitus position, the anterior and lateral aspects of the T12, L1, and L2 vertebrae were approached via an extrapleural-retroperitoneal route. Two screws were percutaneously inserted into the spinous process of the L1 vertebra, and the dynamic reference frame (DRF) was fixed to the screws after rubber wrapping. Vertebral body screws were inserted after the registration. After anterior release, the DRF and the screws in the spinous process were removed prior to a reduction maneuver. The operation time was 240 minutes. Postoperative imaging studies showed adequate decompression of the spinal canal and an anatomically correct spinal reconstruction. The preoperative kyphotic angle of 50 degrees decreased to 20 degrees after the surgery. There were no complications associated with the use of the computer-assisted navigation system.