[Vertebral body replacement with Synex in combined posteroanterior surgery for treatment of thoracolumbar injuries].

OBJECTIVE: Reduction and stabilization of unstable spinal injuries with reconstruction of the anterior column resulting in a permanent restitution of the physiologic spinal alignment, stability and load-bearing capacity. INDICATIONS: Unstable injuries and lesions of the spine from T4 to L5 resulting in a reduced load-bearing capacity of the anterior spinal column caused by vertebral fractures and injury of the intervertebral disks, posttraumatic kyphotic deformities, pathologic fractures, tumors. Relative indications: younger patients with monosegmental injuries; patients with severe osteoporosis. CONTRAINDICATIONS: Concomitant serious thoracic injuries or preexisting cardiopulmonary disease precluding anterior intervention. SURGICAL TECHNIQUE: Combined posteroanterior treatment with (1) posterior reduction and stabilization with an internal fixator and interlaminar fusion with autogenous bone grafts; (2) thoracoscopic anterior approach with reconstruction of the anterior column with a distractible titanium implant for vertebral body replacement (Synex), interbody fusion with autogenous bone grafts and/or beta-tricalciumphosphate.
RESULTS: 50 consecutive patients (29 men, 21 women) with an average age of 43 years (20-77 years) were treated with Synex. The most frequent indication was acute injury (n = 36). A bisegmental reconstruction was performed in 30 patients, a monosegmental in 20. Mean follow-up 19.5 months (14-31 months) in 41 patients. 18/33 patients returned to their previous occupation, and 32/41 resumed their recreational activities. At follow-up, 32/41 were free of symptoms or complained of only occasional pain, eight reported marked pain and one severe pain. A VAS spine score (0-100 points, visual analog scale, 19 items) was used for assessment; the preoperative score amounted to 83.1 +/- 20.2 (21-100), the postoperative score to 63.8 +/- 19.5 (25-99). The mean decrease in VAS spine score was 19.3 +/- 22.3. The average degree of correction measured radiologically for patients with fresh injuries or posttraumatic malalignment was 18.6 degrees +/- 10 degrees and the loss of correction 2.1 degrees +/- 2.9 degrees . No implant-related complications were observed.