Should Mini-Thoracotomy Be the Preferred Anterior Approach to the Thoracic Spine?

Objectives To compare the short- and mid-term surgical outcomes in patients undergoing mini-thoracotomy (MT) and conventional open thoracotomy (COT) as anterior approaches to the thoracic spine. Methods Data were collected for adults who underwent thoracic spine procedures via an anterior surgical approach for various indications at the Department of Neurosurgery, Queen Elizabeth Hospital Birmingham (QEHB), between 2016 and 2021. Electronic medical records and clinical imaging of the patients enrolled on the study were reviewed. Primary outcomes measured were complications and post-operative pain levels. Secondary outcomes included the lengths of hospitalisation and intensive care unit (ICU) stays, estimated blood loss (EBL), duration and output of the post-operative chest drain, operation time, and radiation exposure. These outcomes were then compared between the MT and COT cohorts. The software, IBM SPSS Statistics, version 28 (IBM Corp., Armonk, NY, USA), alongside parametric and non-parametric tests, was used, with a p-value set at <0.05. Results A total of 31 patients (18 females and 13 males) with an average age of 53±15 were included. Fourteen underwent MT, while 17 had COT. There were no significant demographic differences between the cohorts. MT resulted in fewer complications, but the difference was not statistically significant. Pain levels were lower at 48 hours post-operation but higher on discharge in MT. Secondary outcome results yielded that the MT group had a statistically significant 80% shorter post-operative ICU stay than the COT group (p=0.034). Duration of the procedure and EBL were comparable in both groups. The differences between duration and output of the chest drain and post-operative opioid use favoured MT, but were not statistically significant. Conclusion Based on our study, MT is non-inferior to COT. MT seemed related to shorter post-operative ICU stay and is potentially positively associated with the other outcomes. However, studies involving larger patient cohorts are required to verify the statistical significance and clinical relevance of these observations.