ANALYSIS OF TECHNIQUES FOR VIDEO-ASSISTED THORACOSCOPIC INTERNAL-FIXATION OF THE SPINE

Between November 1, 1995, and January 31, 1996, four separate thoracos copic spinal fixation surgeries were performed via extended manipulati ng channels using the so-called three-portal technique. The diagnoses included three spinal metastases and one T11 burst fracture. All patie nts had myelopathy at presentation. Using the three-portal technique, the conventional spinal instruments and fixation devices could be pass ed freely through the extended manipulating channels (usually 3-4 cm) into the chest cavity and manipulated by techniques similar to these u sed in standard open procedures. a reduction-fixation spinal plate wit h variable screw and plate anchoring angles was successfully inserted in the procedures. The total length of the operation ranged from 3.5 t o 5 h (average 4.3 h), and the total blood loss was 1000-2500 ml (aver age 1500 ml). There were no intraoperative deaths, and no patient show ed neurological deterioration following the procedures. On the basis o f these results, we believe that the combination of video-assisted tho racoscopy and conventional spinal instruments presented in this report would be an ideal method for performing these procedures. Throughout the operation, only one trocar was employed for introducing the thorac oscope. The thoracoports were used temporarily during tumor tissue ret rievals. This technique makes thoracoscopy-assisted spinal fixation si mple and easy. It allows greater control of intraoperative vessel blee ding and reduces the number of portals required during the procedure ( on average to 3). In addition, the technique reduced the amount of end oscopic materials required for the procedure, thus reducing the cost o f treatment.