Application of mini-open approach beside costodiaphragmatic recess in anterior thoracolumbar spine surgery
10.11958/j.issn.0253-9896.2015.02.022
- VernacularTitle:小切口肋膈隐窝外入路在胸腰段脊柱侧前方手术中的应用
- Author:
Baoshan XU
;
Xinlong MA
;
Qun XIA
;
Xiaolin ZHANG
;
Hongfeng JIANG
;
Qiang YANG
;
Yue LIU
;
Ning JI
- Publication Type:Journal Article
- Keywords:
thocolumbar spine;
approach;
costodiaphragmatic recess
- From:
Tianjin Medical Journal
2015;(2):196-198,199
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the value of mini-open approach beside costodiaphragmatic recess in thoracolumbar spine surgery. Methods This approach was applied in 31 anterior thoracolumbar spine surgeries, including 22 men and 9 women, with a mean age of 41 years old (range, 26-58 yrs). The diagnosis were burst fractures in 27 cases (T12 level in 12 cas?es and L1 level in 15 cases) and disc herniations with osteochondrosis in 4 cases. An antero-lateral 10-15 (average is 12) cm incision was performed, then the 11th rib was resected and the extraperitoneal space below diaphragma was disconnected. The pleura fold was identified beneath the rib bed, so the gap beside the costdiaphragmatic recess was entered through an in?cision beyond the fold. The diaphragm and medial arcuate ligament were clipped and vertebral body from T11 to L2 were ex?posed. Results The lateral side of T11 to L2 vertebral body was sufficiently exposed in all the 31 patients. In 26 patients, the pleura fold was beyond the bed of the 11th rib, so the 11th intercostals vessel and nerve were exposed and protected, and the costodiaphragmatic recess was reached through the superior border of the 12th rib. Laceration of pleura occurred in 4 cases af?ter it was sutured, but the extra-pleura approach could still be used after repairing without invading into thorax. Fixation and fusion were performed from T11 to L2. Complications include intercostals nerve pain were seen in 3 cases, which resolved with conservative treatment. Conclusion The mini-open approach beside costodiaphragmatic recess can be used in anterior thoraclumbar spine surgery with sufficient explosion and minimum injury in which thoracic cavity.
