Abstract

MATTA, JAVIER; ARRIETA, VICTOR; GONZALEZ, MARIO  and  JAIMES, LEONARDO. ANTEROLATERAL SELECTIVE APPROACH TO MANAGING FRACTURES OF THE REGION THORACOLUMBAR (T12, L1, L2) : DESCRIPTION OF A TECHNIQUE FOR GASH MINIMUM QUIRÚRGICA. rev.fac.med [online]. 2013, vol.21, n.1, pp.54-62. ISSN 0121-5256.

Thoracolumbar junction is the area more frequently affected by spine closed trauma. Anatomically, it is a transitional zone between the rigid thoracic spine and the mobile lumbar spine. Usually, wedge or burst fractures occur, with or without neurological deficit. It can be treated through anterolateral approach in patients with inveterated wedges, post-traumatic kyphosis and bursts with partial deficit justifying decompression. A technique performed by spine orthopedic surgeons is described, carried out with minimal incision through extrapleural, subdiaphragmatic, retroperitoneal approach, avoiding thoracostomy, practiced in cadaveric dissection and preliminary report of its application in thoracolumbar trauma patients. Cadaveric dissection was performed with the technique whose incision is 10 cm, starting in the external edge of paravertebral muscles, following the direction of the false ribs. For T12 fractures, T11 to L1 are exposed, eleventh and twelfth ribs are removed, continuing with extrapleural subdiaphragmatic retroperitoneal dissection. For L1 fractures requiring T12 to L2 vertebral exposition, twelfth rib is removed and the above described dissection is continued. For L2 fractures requiring L1 to L3 vertebral exposition no costal resection is done but a retroperitoneal dissection. Through the same approach, spinal decompression, reconstruction with costal bone or iliac crest grafts, interposition of titanium cages and internal fixation as appropriate are perfomed. Additionally, a case-series-type descriptive study is done with patients undergoing this approach. The experience with cadaveric dissection, repairs, and feasible complications is showed. The clinical experience includes 21 intervened patients with wedge fractures, post-traumatic kyphosis, and burst with partial neurological deficit. Internal fixation is done through a system using vertebral bars and screws performing reduction of fracture and associated deformity.

Keywords : Selective approach; thoracolumbar spine.

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