Minimally invasive retropleural approach for central thoracic disc herniation

The management of symptomatic thoracic disc herniation (TDH) has evolved tremendously ever since the first laminectomy was performed. The last decade has witnessed the evolution of minimally invasive approaches for TDH most of which have been posterior/posterolateral. Traditional anterior approaches involve a thoracotomy or more recently, thoracoscopic techniques. The authors describe a less invasive anterior retropleural surgical approach to address central thoracic disk herniations which is less extensive than a thoracotomy and allows better anterior access than posterior or posterolateral approaches. The retropleural approach allows the use of the operative microscope with a tubular retractor in the anterior thoracic spine.

7 patients with central disc herniation who were managed with the minimally invasive lateral retropleural approach from 2007-2010 at our institution were included in the study. Surgical technique consisted of a lateral position followed by retro-pleural exposure through tubular retractor system without the need of intraoperative lung collapse. Clinical details including age, sex, clinical presentation, surgical details, complications and outcome at last follow-up were analyzed.

Patients age ranged in age from 30 to 70 years (mean: 52 years). The duration of symptoms ranged from 4 days to 3 years. All patients presented with thoracic myleopathy on physical examination. The average length of stay in the hospital was 2.6 days (range: 1-4 days). Follow-up was available for all the patients. Myelopathy was assessed by the Nurick scale. On examination, 3 of 7 patients improved by one point on the Nurick scale. No patient deteriorated after surgery. There were no complications related to the approach.

A minimally invasive retropleural approach using tubular retractor system for central thoracic disc herniation is feasible and may be a less invasive anterior alternative to a thoracotomy.