Technical modifications and decision-making to reduce morbidity in thoracic disc surgery: An institutional experience...

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Spine Surgery

Background:

• Symptomatic thoracic disc herniation (TDH) is a rare condition with substantial treatment risks.
• Minimally invasive surgical techniques aim to mitigate these risks.

Purpose of the Study:

• To evaluate strategies for avoiding and managing complications associated with thoracic disc surgery.
• To assess the efficacy of a thoracoscopic-tubular retractor approach in reducing surgical morbidity.

Main Methods:

• Retrospective review of 64 thoracic disc herniation cases (2000-2012).
• Analysis of complications, avoidance, and management strategies.
• Development and application of a thoracoscopic-tubular retractor approach to minimize access-related morbidity.

Main Results:

• 15 patients (23%) experienced complications; most underwent anterior minimally-invasive surgery.
• Intercostal neuralgia resolved with nerve blocks/radiofrequency lesioning.
• Dural tears were managed successfully with repair, lumbar drains, and chest tubes.
• Thoracoscopic-tubular retractor approach showed low morbidity (13 cases, no major complications).

Conclusions:

• Careful approach selection, preoperative level marking, and tubular retractors with thoracoscopic guidance can reduce thoracic disc surgery morbidity.
• Routine chest tube placement for anterior operations and lumbar drains for dural tears are recommended.
• Prospective comparative studies are needed to validate these techniques.