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Blood transfusions after thoracoscopic anterior thoracolumbar vertebrectomy

  • Clinical Article
  • Published:
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Abstract

Purpose

Anterior vertebral body reconstruction (AVBR) for trauma or tumor involves corpectomy and placement of hardware to reconstitute the anterior weight-bearing stability of the spine. We report our clinical experience with thoracoscopic techniques for AVBR.

Methods

We retrospectively analyzed patients who underwent thoracoscopic AVBR surgery for expandable cage placement. We report pathological condition, patient age, vertebral body level, operative time, estimated blood loss (EBL), and need for blood transfusion.

Results

Twenty-one expandable cages were placed thoracoscopically in 15 fractures and six tumors. In fracture cases, mean age, operative time, EBL, and transfusion rate were 36.7 years, 4.9 h, 543 mL, and 7% (1/15), respectively. In tumor cases, mean age, operative time, EBL, and transfusion rate were 61.9 years, 4.9 h, 758 mL, and 17% (1/6), respectively.

Conclusions

Thoracoscopic AVBR with expandable cages can be accomplished safely with acceptable operative times and blood loss and low transfusion rates.

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References

  1. Amini A, Beisse R, Schmidt MH (2005) Thoracoscopic spine surgery for decompression and stabilization of the anterolateral thoracolumbar spine. Neurosurg Focus 19(6):E4

    PubMed  Google Scholar 

  2. Amini A, Beisse R, Schmidt MH (2007) Thoracoscopic debridement and stabilization of pyogenic vertebral osteomyelitis. Surg Laparosc Endosc Percutan Tech 17:354–357

    Article  PubMed  Google Scholar 

  3. Beisse R (2006) Endoscopic surgery on the thoracolumbar junction of the spine. Eur Spine J 15:687–704

    Article  PubMed  Google Scholar 

  4. Beisse R (2007) Video-assisted techniques in the management of thoracolumbar fractures. Orthop Clin North Am 38:419–429

    Article  PubMed  Google Scholar 

  5. Beisse R, Muckley T, Schmidt MH, Hauschild M, Buhren V (2005) Surgical technique and results of endoscopic anterior spinal canal decompression. J Neurosurg Spine 2:128–136

    Article  PubMed  Google Scholar 

  6. Bernard AC, Davenport DL, Chang PK, Vaughan TB, Zwischenberger JB (2009) Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg 208:931–937; discussion 938-939

    Article  PubMed  Google Scholar 

  7. Bomback DA, Charles G, Widmann R, Boachie-Adjei O (2007) Video-assisted thoracoscopic surgery compared with thoracotomy: early and late follow-up of radiographical and functional outcome. Spine J 7:399–405

    Article  PubMed  Google Scholar 

  8. Ernstberger T, Kogel M, Konig F, Schultz W (2005) Expandable vertebral body replacement in patients with thoracolumbar spine tumors. Arch Orthop Trauma Surg 125:660–669

    Article  CAS  PubMed  Google Scholar 

  9. Flohe S, Kobbe P, Nast-Kolb D (2007) Immunological reactions secondary to blood transfusion. Injury 38:1405–1408

    Article  CAS  PubMed  Google Scholar 

  10. Furrer M, Rechsteiner R, Eigenmann V, Signer C, Althaus U, Ris HB (1997) Thoracotomy and thoracoscopy: postoperative pulmonary function, pain and chest wall complaints. Eur J Cardiothorac Surg 12:82–87

    Article  CAS  PubMed  Google Scholar 

  11. Kan P, Schmidt MH (2008) Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease. Neurosurg Focus 25(2):E8

    Article  PubMed  Google Scholar 

  12. Khoo LT, Beisse R, Potulski M (2002) Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery 51:S104–117

    PubMed  Google Scholar 

  13. Kim DH, Jahng TA, Balabhadra RS, Potulski M, Beisse R (2004) Thoracoscopic transdiaphragmatic approach to thoracolumbar junction fractures. Spine J 4:317–328

    Article  PubMed  Google Scholar 

  14. Kossmann T, Jacobi D, Trentz O (2001) The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine. Eur Spine J 10:396–402

    Article  CAS  PubMed  Google Scholar 

  15. Lonner BS, Kondrachov D, Siddiqi F, Hayes V, Scharf C (2007) Thoracoscopic spinal fusion compared with posterior spinal fusion for the treatment of thoracic adolescent idiopathic scoliosis. Surgical technique. J Bone Joint Surg Am 89(Suppl 2 Pt.1):142–156

    Article  PubMed  Google Scholar 

  16. Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM (2003) Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 54:898–905 discussion 905–907

    Article  PubMed  Google Scholar 

  17. Muckley T, Schutz T, Schmidt MH, Potulski M, Buhren V, Beisse R (2004) The role of thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis. Spine 29:E227–233

    Article  PubMed  Google Scholar 

  18. Oskouian RJ, Johnson JP (2005) Endoscopic thoracic microdiscectomy. J Neurosurg Spine 3:459–464

    Article  PubMed  Google Scholar 

  19. Oskouian RJ Jr, Johnson JP (2002) Vascular complications in anterior thoracolumbar spinal reconstruction. J Neurosurg 96:1–5

    Article  PubMed  Google Scholar 

  20. Oskouian RJ Jr, Johnson JP, Regan JJ (2002) Thoracoscopic microdiscectomy. Neurosurgery 50:103–109

    Article  PubMed  Google Scholar 

  21. Payer M, Sottas C (2008) Mini-open anterior approach for corpectomy in the thoracolumbar spine. Surg Neurol 69:25–31 discussion 31-22

    Article  PubMed  Google Scholar 

  22. Ragel BT, Amini A, Schmidt MH (2007) Thoracoscopic vertebral body replacement with an expandable cage after ventral spinal canal decompression. Neurosurgery 61:ONS317–ONS323

    Article  Google Scholar 

  23. Schreiber U, Bence T, Grupp T, Steinhauser E, Muckley T, Mittelmeier W, Beisse R (2005) Is a single anterolateral screw–plate fixation sufficient for the treatment of spinal fractures in the thoracolumbar junction? A biomechanical in vitro investigation. Eur Spine J 14:197–204

    Article  PubMed  Google Scholar 

  24. Thongtrangan I, Le H, Park J, Kim DH (2004) Minimally invasive spinal surgery: a historical perspective. Neurosurg Focus 16(1):E13

    Article  PubMed  Google Scholar 

  25. Weber RS, Jabbour N, Martin RC 2nd (2007) Anemia and transfusions in patients undergoing surgery for cancer. Ann Surg Oncol 15:34–45

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors thank Kristin Kraus for her editorial assistance in preparing this paper.

Author information

Author notes

  1. Brian T. Ragel

    Present address: Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA

Authors and Affiliations

  1. Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA

    Brian T. Ragel, Peter Kan & Meic H. Schmidt

  2. Spinal Oncology Service, Huntsman Cancer Institute, Salt Lake City, UT, USA

    Meic H. Schmidt

  3. Department of Neurosurgery, Clinical Neurosciences & Spine Center, University of Utah, 175 N. Medical Dr. East, Salt Lake City, UT, 84132, USA

    Meic H. Schmidt

Authors
  1. Brian T. Ragel
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  2. Peter Kan
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  3. Meic H. Schmidt
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Corresponding author

Correspondence to Meic H. Schmidt.

Additional information

Comment

The authors provide another study in the ongoing attempt to minimize access trauma and intra- and postoperative complications by moving away from large thoracotomies and toward smaller, less invasive techniques for vertebral body reconstruction. There can be no doubt that patients will benefit from such strategies. Improvement of hardware and endoscopic techniques has provided opportunities that were almost non-existent a couple of years ago. Unfortunately, this study does have significant limitations to draw more general conclusions from it. Which of the available techniques using either endoscopes or smaller incisions will prove to be the best way needs to be determined in prospective study with random assignment of the patients.

Joerg Klekamp

Quakenbrueck, Germany

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Ragel, B.T., Kan, P. & Schmidt, M.H. Blood transfusions after thoracoscopic anterior thoracolumbar vertebrectomy. Acta Neurochir 152, 597–603 (2010). https://doi.org/10.1007/s00701-009-0549-1

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  • DOI: https://doi.org/10.1007/s00701-009-0549-1

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