ENDOSCOPIC CONTROLLED SPLITTING OF THE DIAPHRAGM - A MINIMAL INVASIVEAPPROACH FOR THE TREATMENT OF THORACOLUMBAR FRACTURES OF THE SPINE

On 90 patients with 93 unstable fractures of the thoracic spine and th e thoracolumbar junction we treated by a minimal invasive procedure be tween may 1996 and april 1998, in 46 patients an endoscopic splitting of the diaphragm was performed. The diaphragma was dissected at its at tachment at the spine and the adjoining costal base. After partial cor porectomy and discectomy, a tri-cortical bone graft has been inserted. An additional stabilization was done by using a plate and screw syste m. The incision of the diaphragm was closed by suturing or using an un iversal endostapler. Controlling the postoperative results a complete closure of the incision was documented by X-ray and CT-scan. There was no conversion to the open procedure or postoperative infection. Split ting the diaphragma opens also the thoracolumbar junction to a minimal invasive treatment and stabilization of fractures.