Minimally invasive retropleural approach for central thoracic disc herniation

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Surgery

Background:

• Management of symptomatic thoracic disc herniation (TDH) has evolved, with a trend towards minimally invasive techniques.
• Traditional anterior approaches include thoracotomy or thoracoscopic methods.
• Posterior/posterolateral approaches are common, but anterior access can be limited.

Purpose of the Study:

• To describe a less invasive anterior retropleural surgical approach for central thoracic disc herniations.
• To evaluate the feasibility and outcomes of this approach compared to traditional methods.
• To assess the utility of the operative microscope with a tubular retractor in the anterior thoracic spine.

Main Methods:

• Retrospective analysis of 7 patients with central TDH treated between 2007-2010.
• Utilized a minimally invasive lateral retropleural approach with a tubular retractor system.
• Surgical technique involved lateral positioning without intraoperative lung collapse; outcomes and complications were analyzed.

Main Results:

• Patient age ranged from 30-70 years (mean 52). Symptom duration varied from 4 days to 3 years.
• All 7 patients presented with thoracic myelopathy; 3 improved by one Nurick scale point post-surgery.
• Average hospital stay was 2.6 days; no complications related to the retropleural approach were observed.

Conclusions:

• A minimally invasive retropleural approach using a tubular retractor system is feasible for central TDH.
• This technique offers a less invasive anterior alternative to thoracotomy.
• The approach allows for effective anterior access and use of the operative microscope.