Minimally Invasive Instrumentation without Fusion during Posterior Thoracic Corpectomies: A Comparison of Percutaneously Instrumented Non-fused Segments with Open Instrumented Fused Segments

Presented at SMISS Annual Forum 2016
By Darryl Lau MD
With Dean Chou MD,

Disclosures: Darryl Lau MD None Dean Chou MD None,

Introduction

During the mini-open transpedicular corpectomy, percutaneous instrumentation without fusion is performed above and below the corpectomy level. 

Aims/Objectives

We wished to evaluate outcomes of these non-fused, yet minimally invasive instrumented levels. 

Methods

Adult patients who underwent posterior thoracic corpectomies with cage reconstruction from 2009 to 2014 were identified. Patients who underwent mini-open corpectomy had percutaneous instrumentation without fusion and patients who underwent open corpectomy had instrumented fusion above and below the corpectomy site. We compared perioperative outcomes and rest of implant failure requiring reoperation between the open (fused) and mini-open (unfused) group. 

Results

A total of 75 patients were identified. Fifty-three patients were available for follow-up: 32 open and 21 mini-open. Mean age was 52.8 years and 56.6% were male. There were no significant differences in baseline variables between the two groups. The overall perioperative complication rate was 15.1%, and there was no significant difference between the open and mini-open group (18.8% vs. 9.5%) (p=0.259). Mean hospital stay was 10.5 days. The open group required a significantly longer stay than the mini-open group (12.8 vs. 7.1 days)(p=0.001). Overall implant failure rate requiring reoperation was 1.9% at 6-months, 9.1% at 1-year, and 14.7% at 2-years. There was no significant difference in re-operation rates between the open and mini-open group at 6-months (3.1% vs. 0.0%, p=0.413), 1-year (10.7% vs. 6.3%, p=0.620), and 2-years (18.2% vs. 8.3%, p=0.438). Mean follow-up was 29.2 months. 

Conclusions

These findings suggest that percutaneous instrumentation without fusion in mini-open transpedicular corpectomies offers similar implant failure and reoperation rates as open instrumented fusion as far out as 2 year follow up.