Introduction: The ventral thoracoscopic spondylodesis of the thoracolumbal spine is an elegant treatment strategy in cases of incomplete vertebral burst fractures.

Materials and Methods: In the years 2002/03 29 patients with incomplete burst fractures of the thoracolumbal spine, were treated by a ventral thoracoscopic spondylodesis and were included prospectively. The individual treatment plan depended on the patient’s general condition and the vertebral stability. The data acquisition was done according the DGU guidelines of documentation preoperative, postoperative, and after 3, 6, 12, and 18 months. After 5 years a follow-up examination was performed in 21 of these patients (9 men, 12 women, average age: 46.3 years, follow-up rate: 72%). 9 patients were treated ventral only. In all of them the ventral spondylodesis was done monosegmental with autologous iliac crest. In 12 cases a dorsoventral procedure was performed, 5 patients ventral monosegmental with iliac crest, and 7 patients bisegmental with cage. Parameters of interest were the bisegmental kyphotic angle, the SF-36 score, the visual analogue scale (VAS), and the morbidity of the surgical approach.

Results: The 5-year results of the 21 patients dependent on the treatment strategy:

5 years/Reposition- Loss of Reposition- VAS- PSC (SF36)- MCS (SF36)

Only three patients complained of intermittent weak pain sensation at the region of the thoracoscopic approach (14%). During the 5 years one revision surgery was performed because of the development of an incisional hernia.

The computertomographic controls of the 14 patients who gained a monosegmental spondylodesis with an iliac crest showed in 12 cases a complete osseous consolidation (86%) after 5 years. In the other two cases the osseous consolidation was only partly visible with an area of consolidation of more than 30% (14%). In both cases a sufficient stability was existent. 4 patients (29%) had no symptoms at the site of the iliac crest removal. 8 patients (57%) reported of weak residual pain, 2 patients (14%) reported of more intense pain sensation.

Conclusions: After 5 years the ventral thoracoscopic spondylodesis of the throracolumbar spine after incomplete burst fractures prove to be a save and successful therapy strategy. There are no significant differences between the isolated ventral spondylodesis and the dorsoventral spondylodesis in respect of loss of reposition of the bisegmental angle, persisting pain sensations, and quality of life after 5 years. The ventral thoracoscopic monosegmental spondylodesis seems to be by trend superior to the bisegmental strategy in respect of the physical summary score.

Aims: Aim of this prospective clinical study was to prove whether there are clinical differences between ms VTS with interposition of an autogenic tricortical bone graft alone and a consecutive dorso-ventral procedure for A 1.2 and A 3.1 fractures of the thoracic and lumbar spine.

Materials und Methods: From 01/2002 to 12/2003 298 pat. with traumatic fractures of the thoracic and lumbar spine were treated and had a prospective clinical and radiological follow-up according to the mc-study of the DGU. For 29 pat. (14 m, 15 f; mean age 33 y) ms VTS was performed either isolated (10) or consecutive after dorsal instrumentation (19). Over the post-OP course with a follow-up of 18 mo. the pat. underwent a questionnaire concerning the morbidity at the surgical approaches, the subjective back function and the Odom-score. The osseous integration of the graft and the resulting loss of correction were investigated within the follow-ups 3, 6, 12 and 18 mo. post-OP.

Results: Concerning the anterior column 83% of the pat. had type A 3.1.1 fractures. All pat. with type B and C injuries underwent consecutive dorso-ventral instrumentation in 2 sessions. In one case revision surgery with bisegmental replacement of the affected vertebral body by a distractible cage was performed due to osteolysis of the bone graft. The other 28 pat. had no intra- or post-OP complications associated with the autogenic bone graft. At the 12 mo. follow-up osseous integration of the bone graft was observed in 28/29 in the CT-scans. The dorsal instrumentation could be removed in 8 of the 19 pat. with a dorso-ventral procedure after a mean of 12,6 mo. The measurements of the CT-scans at 18 mo. showed an average loss of correction (bisegmental) of 1,5° in the isolated ventral group and of 2,7° in the dorso-ventral group (p < 0,05). After 18 mo. Odom-score and subjective back function increased by 49% respectively 57% compared to the post-OP values (p< 0,05). Concerning the morbidity at the surgical approaches the pat. stated a pain relief of up to 73%.

Conclusions: Ms VTS with interposition of an autogenic bone graft of the iliac crest is an appropriate and meanwhile standardized minimal-invasive procedure with a low morbidity at the surgical approach. In this study a high potential for graft integration with a low amount of loss of correction could be detected in both groups (p < 0,05). For the mentioned indications the isolated ventral technique can be seen equal to the dorso-ventral procedure in 2 sessions. However the indication for an isolated ventral procedure has to be reconsidered carefully concerning increasing age and level of osteoporosis.

Due to the fact that the treatment of distal femoral fractures is a therapeutic challenge, new specific implants were continuously developed. The techniques should guarantee a reliable bone healing for two different groups. For young patients with high energy trauma and more or less severe collateral injury and for old patients with osteopenic bone, weal soft tissue and a high rate of co-morbidity. Present widespread techniques are reduction and fixation with LISS plate or retrograde nails. In this clinical study from 2003 to 2006 we compared our supracondylar nail (SCN, Stryker) with the LISS plate. We were looking at a series of 77 patients (55 SCN and 23 LISS) with A (36) and C (41) fractures of the distal femur. 43 (78%) of the SCN group healed without complications, 1 malrotation, 1 case of infection, 2 pseudarthrosis and 5 problems with the distal locking screws were observed. In the LISS group only 23 (56%) healed primarily, whereas the complications occured more frequent. Beside radiographic control and clinical examination the success of operation was assessed with a standardised questionare (KOOS). The SCN group showed again a higher rate of satisfaction compared to LISS.

Conclusion: The SCN is working in A and also in complex C fractures. Furthermore we saw less rate of complications and more satisfied patients with the SCN.