The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine

In 65 consecutive cases of trauma (n=55), pseudo-arthrosis (n=4) and metast asis (n=6), anterior reconstruction of the thoracic and lumbar spine was pe rformed using a new minimal invasive but open access procedure. No operatio n had to be changed into an open procedure. The thoracolumbar junction was approached by a left-sided mini-thoracotomy (n=50), the thoracic spine by a right-sided mini-thoracotomy (n=8) and the lumbar spine by a left sided mi ni-retroperitoneal approach (n=7), using a new table-mounted retractor syst em called SynFrame (Stratec Medical, Switzerland). The anterior column was reconstructed using a variety of materials: autologous tri-cortical crest ( n=11), autologous spongiosa (n=12), allografts (n=4) and cages (n=38). The mean overall operating time was 170 min (range 90-295 min); the time of sur gery varied, depending on the spine pathology and the magnitude of the inte rvention in the anterior part of the spine. Mean overall blood loss was 912 ml, and only 7 out of the 65 patients needed blood transfusions. There wer e neither intra- nor postoperative complications related to the minimal acc ess in particular, nor visceral/vascular complications. No intercostal neur algia, no post-thoracotomy pain syndromes, no superficial or deep wound inf ections and no deep venous thromboses occurred. Four cases of pseudo-obstru ction were treated conservatively. In this study, we describe the new minim al access technology to the anterior part of the thoracal and lumbar spine on the basis of 65 cases completed within 1 year. This open, but minimal in vasive, access technology offers, in our view, additional advantages to the "pure" endoscopic procedures of spinal surgery.