Spinal cord anterior decompression for delayed spinal cord paralysis after osteoporotic vertebral compression fracture: application of thoracoscopic approach

The purpose of this study was to evaluate the efficacy of thoracoscopic techniques applied for anterior spinal cord decompression and fusion in osteoporotic thoracolumbar vertebral pseudoarthrosis with paralysis that otherwise require open thoracotomy and diaphragm section. Thirteen patients (average age, 65.7 years old) underwent this operation. Unilateral lung ventilation, otherwise bilateral high frequency jet ventilation was applied for general anesthesia. Three ports were routinely prepared through the intercostal spaces. Minimal subperiosteal dissection of the diaphragm was made from its insertion to L1 vertebra by 2 cm. Following corpectomy procedure of collapsed vertebra, spinal cord was decompressed and spinal fusion was performed in either of one or two stages. Spinal cord decompression could be achieved under bright illumination and a magnified view by assistance of endoscope system. Anterior spinal reconstruction could be performed by a titanium mesh cage packed with local bone in 9, or by autogenic iliac strut bone graft in 4 cases. There was no mortality and no major endoscope-related morbidity such as dural tear, spinal cord, lung, or major vascular injury except one case of pulmonary embolism. By avoiding open thoracotomy, thoracoscopic approach resulted in less postoperative wound pain and better respiratory function for such aged high-risk patients.