Thoracoscopic approaches to the thoracic spine: Experience with 241 surgical procedures

Patrick P. Han, Kathy Kenny, Curtis A. Dickman

Research output: Contribution to journalArticle

69 Scopus citations

Abstract

INTRODUCTION: Microsurgical thoracoscopic approaches to the thoracic spine allow access to the spinal cord, spinal nerves, disc spaces, vertebral bodies, paravertebral soft tissues, and sympathetic chain with minimal invasiveness. METHODS: Between January 1994 and January 2000, 241 thoracoscopic procedures were performed: 164 thoracic sympathectomies, 60 discectomies, 5 neurogenic tumor resections, 8 corpectomies and spinal reconstructions, 2 anterior releases, and 2 biopsies. Cases were reviewed to evaluate the efficacy, surgical results, and complications of the thoracoscopic procedures. RESULTS: An adequate sympathectomy was achieved in all 164 sympathectomies. There was 100% relief of palmar and 95% relief of axillary hyperhidrosis. Reflex sympathetic dystrophy responded poorly to sympathectomy with recurrent pain. Thoracoscopic discectomy achieved complete decompression in 98% of patients. Gross total tumor resection was achieved in all five paraspinal neurogenic tumors. There was no operative mortality. Morbidity compared favorably with open surgical approaches to the thoracic spine. CONCLUSION: Thoracoscopic spinal surgery is an effective technique that provides full, direct access to the ventral thoracic spine. Its morbidity rate appears to be lower than that associated with open thoracotomy. It improves patient comfort and cosmetic results and shortens recovery. This technique has become the authors' surgical approach of choice for removing benign intrathoracic paraspinal neurogenic tumors and central herniated thoracic discs and for performing biopsies and thoracic sympathectomies. The senior author still prefers open surgical approaches for most thoracic corpectomies and spinal reconstruction procedures.

Original languageEnglish (US)
Pages (from-to)88-95
Number of pages8
JournalNeurosurgery
Volume51
Issue number5 SUPPL.
DOIs
StatePublished - Nov 1 2002

Keywords

  • Discectomy
  • Herniated thoracic disc
  • Hyperhidrosis
  • Neurofibroma
  • Paraspinal tumors
  • Schwannoma
  • Sympathectomy
  • Thoracoscopic spinal surgery
  • Thoracoscopy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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