Minimally invasive approaches for thoracic decompression from discectomy to corpectomy.

ABSTRACT

Surgical approaches to the thoracic spine have evolved in recent decades with the development of advanced instrumentation techniques and an increased emphasis on reducing surgical morbidity. Multiple methods to access this area have been described, from a conventional open to a more minimally invasive approach, such as anterior-based, via supra- or transmanubrium, via thoracoscopy, lateral-based approach, extreme lateral mini-thoracotomy, and dorsolateral approaches, transpedicular, costotransversectomy and the lateral extracavitary access. The technique used is often determined by the affected spinal level, pathological process, and surgeon preference. Each of these approaches requires expertise in the specific technique, and has its own complication profile. Over time, these techniques have undergone improvement to limit approach-related morbidity and minimize soft tissue dissection, resulting in better patient outcomes. These different approaches present distinct advantages and disadvantages for which a thorough understanding of the regional anatomy is required to avoid approach-related complications. For these reasons, surgeon experience and confidence in the various techniques are major factors in the decision-making process and patient outcomes.