Thoracoscopic Approaches

Abstract

The anatomy of the thoracic spine with a narrow thoracic spinal canal, the sensitivity of the spinal cord to minimal retraction, the ribcage, and the proximity to the lungs, heart, great vessels, and the diaphragm make selection of surgical approach to the thoracic spine of utmost importance. Spine surgeons first started treating patients with thoracic herniated discs through a posterior approach by laminectomy with or without discectomy. In 1969, Perot and Munro compiled 91 cases of thoracic herniated disc treated from a dorsal approach. Of the 91 patients, 16 became paraplegic and 6 died [1]. Of the patients with disc herniations in the central portion of the canal, the rate of paraplegia was 26 % and mortality was 9 %. The poor results highlighted the sensitivity of the spinal cord to retraction and the difficulty in treating anterior thoracic spine pathology. To obtain a more direct visualization and minimize retraction of the spinal cord, posterolateral (including transpedicular and transfacet), lateral (including costotransversectomy and extracavitary), and transthoracic approaches were developed.