European Spine Journal

, Volume 19, Supplement 1, pp 52–65 | Cite as

Endoscopic surgery on the thoracolumbar junction of the spine

  • Rudolf Beisse
Review Article


The thoracolumbar junction is the section of the truncal spine most often affected by injuries. Acute instability with structural damage to the anterior load bearing spinal column and post-traumatic deformity represent the most frequent indications for surgery. In the past few years, endoscopic techniques for these indications have partially superseded the open procedures, which are associated with high access morbidity. The particular position of this section of the spine, which lies in the border area between the thoracic and abdominal cavities, makes it necessary in most cases to partially detach the diaphragm endoscopically in order to expose the operation site, and this also provides access to the retroperitoneal section of the thoracolumbar junction. A now standardised operating technique and instruments and implants specially developed for the endoscopic procedure, from angle stable plate and screw implants to endoscopically implantable vertebral body replacements, have gradually opened up the entire spectrum of anterior spine surgery to endoscopic techniques.


Thoracolumbar junction Endoscopic spine surgery Spinal canal decompression Spinal lesions Diaphragm detachment 


Conflict of interest statement

The author receives royalties from Aesculap, Tuttlingen, Germany and was involved in the technical development of MACS-TL® (constraint plate and screw system for endoscopic anterior instrumentation) and Hydrolift® (Vertebral Body Replacement Device) as a consultant to Aesculap.


  1. 1.
    Aebi M, Mohler J, Zach G, Morscher E (1986) Analysis of 75 operated thoracolumbar fractures and fracture dislocations with and without neurological deficit. Arch Orthop Trauma Surg 105:100–112CrossRefPubMedGoogle Scholar
  2. 2.
    Beisse R (2006) Endoscopic surgery on the thoracolumbar junction of the spine. Eur Spine J 15:687–704CrossRefPubMedGoogle Scholar
  3. 3.
    Beisse R (2007) Video-assisted techniques in the management of thoracolumbar fractures. Orthop Clin N Am 38:419–429CrossRefGoogle Scholar
  4. 4.
    Beisse R, Muckley T, Schmidt MH, Hauschild M, Buhren V (2005) Surgical technique and results of endoscopic anterior spinal canal decompression. J Neurosurg Spine 2:128–136CrossRefPubMedGoogle Scholar
  5. 5.
    Beisse R, Potulski M, Bühren V (2001) Endoscopic techniques for the management of spinal trauma. Eur J Trauma 27:275–291Google Scholar
  6. 6.
    Beisse R, Potulski M, Temme C, Buhren V (1998) Endoscopically controlled division of the diaphragm. A minimally invasive approach to ventral management of thoracolumbar fractures of the spine. Unfallchirurg 101:619–627CrossRefPubMedGoogle Scholar
  7. 7.
    Blauth M, Knop C, Bastian L (1998) Brust- und Lendenwirbelsäule. Springer, BerlinGoogle Scholar
  8. 8.
    Bradford DS, McBride GG (1987) Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop Relat Res pp May:201–216Google Scholar
  9. 9.
    Cusick JF, Myklebust J, Zyvoloski M, Sances A Jr, Houterman C, Larson SJ (1982) Effects of vertebral column distraction in the monkey. J Neurosurg 57:651–659CrossRefPubMedGoogle Scholar
  10. 10.
    Dickman CA, Rosenthal DJ, Perin NI (1999) Thoracoscopic spine surgery. Thieme, New YorkGoogle Scholar
  11. 11.
    Esses SI, Botsford DJ, Kostuik JP (1990) Evaluation of surgical treatment for burst fractures. Spine 15:667–673CrossRefPubMedGoogle Scholar
  12. 12.
    Faciszewski T, Winter RB, Lonstein JE, Francis D, Johnson L (1995) The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. Spine 20:1592–1599PubMedGoogle Scholar
  13. 13.
    Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia 7:179–192PubMedGoogle Scholar
  14. 14.
    Gaebler C, Maier R, Kutscha-Lissberg F, Mrkonjic L, Vecsei V (1999) Results of spinal cord decompression and thoracolumbar pedicle stabilisation in relation to the time of operation. Spinal Cord 37:33–39CrossRefPubMedGoogle Scholar
  15. 15.
    Gertzbein SD, Court-Brown CM, Marks P, Martin C, Fazl M, Schwartz M, Jacobs RR (1988) The neurological outcome following surgery for spinal fractures. Spine 13:641–644PubMedGoogle Scholar
  16. 16.
    Hodgson AR, Stock FE (1956) Anterior spinal fusion a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg 44:266–275CrossRefPubMedGoogle Scholar
  17. 17.
    Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh S, Fujiya M (1997) Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Jt Surg Am 79:69–83Google Scholar
  18. 18.
    Kim DH, Jahng TA, Balabhadra RS, Potulski M, Beisse R (2004) Thoracoscopic transdiaphragmatic approach to thoracolumbar junction fractures. Spine J 4:317–328CrossRefPubMedGoogle Scholar
  19. 19.
    Knop C, Blauth M, Bühren V, Hax P-M, Kinzl L, Mutschler W, Pommer A, Ulrich C, Wagner S, Weckbach A, Wetzensen A, Wörsdörfer O (2001) Operative treatment of thoracolumbar fractures-part 3: follow-up. Results of prospective multicenter study by the working group “spine” of the German Society of Trauma surgery. Unfallchirurg 104:583–600CrossRefPubMedGoogle Scholar
  20. 20.
    Knop C, Lange U, Bastian L, Oeser M, Blauth M (2001) Biomechanical compression tests with a new implant for thoracolumbar vertebral body replacement. Eur Spine J 10:30–37CrossRefPubMedGoogle Scholar
  21. 21.
    Korovessis P, Piperos G, Sidiropoulos P, Karagiannis A, Dimas T (1994) Spinal canal restoration by posterior distraction or anterior decompression in thoracolumbar spinal fractures and its influence on neurological outcome. Eur Spine J 3:318–324CrossRefPubMedGoogle Scholar
  22. 22.
    Louis R (1977) Les theories de l’instabilite’. Rev Chir Orthop 63:423–425PubMedGoogle Scholar
  23. 23.
    Mack MJ, Regan J, Bobechko WP, Acuff TE (1993) Applications of thoracoscopy for diseases of spine. Ann Thorac Surg 56:736–738PubMedCrossRefGoogle Scholar
  24. 24.
    Magerl F, Aebi S, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201CrossRefPubMedGoogle Scholar
  25. 25.
    Pedowitz RA, Garfin SR, Massie JB, Hargens AR, Swenson MR, Myers RR, Rydevik BL (1992) Effects of magnitude and duration of compression on spinal nerve root conduction. Spine 17:194–199CrossRefPubMedGoogle Scholar
  26. 26.
    Perrouin-Verbe B, Lenne-Aurier K, Robert R, Auffray-Calvier E, Richard I, Mauduyt de la Greve I, Mathe JF (1998) Post-traumatic syringomyelia and post-traumatic spinal canal stenosis: a direct relationship: review of 75 patients with a spinal cord injury. Spinal Cord 36:137–143CrossRefPubMedGoogle Scholar
  27. 27.
    Regan JJ, Mack MJ, Oicetti GD (1995) A technical report on video-assisted thoracoscopy in thoracic spinal surgery. Preliminary description. Spine 20:831–837CrossRefPubMedGoogle Scholar
  28. 28.
    Rosenthal D, Rosenthal R, Simone A (1994) Removal of a protruded disc using microsurgery endoscopy. Spine 19:1087–1091CrossRefPubMedGoogle Scholar
  29. 29.
    Schultheiss M, Hartwig E, Kinzl L, Claes L, Wilke HJ (2004) Thoracolumbar fracture stabilization: comparative biomechanical evaluation of a new video-assisted implantable system. Eur Spine J 13:93–100CrossRefPubMedGoogle Scholar
  30. 30.
    Schultheiss M, Hartwig E, Sarkar M, Kinzl L, Claes L, Wilke HJ (2005) Biomechanical in vitro comparison of different mono- and bisegmental anterior procedures with regard to the strategy for fracture stabilisation using minimally invasive techniques. Eur Spine J 15:82–89CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Spine Center MunichOrthopedic Hospital München-HarlachingMunichGermany

Personalised recommendations