Endoscopic medial parascapular approach to the thoracic spine

The traditional endoscopic-assisted approaches to the thoracic spine between the 4th and 8th thoracic vertebrae, whether in lateral or prone positions, are done ventrolateral to the scapula. Accordingly, the distance between the working portal and the spinal target is relatively long, and this increases the difficulty of the endoscopic surgery. Exposure of the spinal target necessitates excessive retraction and/or deflation of the corresponding lung. Both maneuvers are undesirable, particularly in old people with chronic obstructive lung disease.

This paper describes an endoscopic-assisted medial parascapular approach in the prone position that offers the surgeon a relatively short access to the upper-mid-thoracic spine. Fifteen patients (10 men and five women), mean age 68 years, with anterior lesions located between the 4th and 8th thoracic vertebrae, constituted this prospective study. The type of the anterior endoscopic procedure varied according to the surgical indication and was as follows; biopsy from a paravertebral swelling in two patients, debridement and fusion in four patients with spondylodiscitis, corpectomy and replacement with telescope cage (X-Tenz) in five patients with spinal tumors, corpectomy and replacement with X-Tenz in two patients with vertebral osteonecrosis, and intersomatic fusion in two patients with fractures. Posterior transpedicular fixation was done in 13 patients in the same sitting.

Conversion to open thoracotomy was not needed. There were no instances of spinal wound infections, neurological deficits, dural tears or vascular injuries. Subcutaneous emphysema developed in one patient and resolved spontaneously. The mean blood loss was 1006.7 ml. Neither pseudarthrosis nor metal failure was encountered. The segmental kyphotic angle decreased from 13.6 degrees at the preoperative period to 9.6 degrees at the immediate postoperative period and reached 11.7 degrees at the end of the follow-up.

The endoscopic medial parascapular approach, done in the prone position, provides the shortest access to anterior spinal lesions between the 4th and 8th thoracic vertebrae. This approach is associated with minimal manipulation and retraction of the lung so that a double-lumen tube is not needed.