Thoracoscopic Spine Surgery for Decompression and Stabilization of the Anterolateral Thoracic and Lumbar Spine

Amin Amini, M.D., M.Sc.; Rudolf Beisse, M.D.; Meic H. Schmidt, M.D.


Neurosurg Focus. 2005;19(6) 

In This Article

Abstract and Introduction

The anterior thoracolumbar spine can be exposed via a variety of approaches. Historically, open anterolateral or posterolateral approaches have been used to gain access to the anterior thoracolumbar spinal column. Although the exposure is excellent, open approaches are associated with significant pain and respiratory problems, substantial blood loss, poor cosmesis, and prolonged hospitalization. With the increasing use of the endoscope in surgical procedures and recent advances in video-assisted thoracoscopic surgery, minimally invasive thoracoscopic spine surgery has been developed to decrease the morbidity associated with open thoracotomy. The purpose of this article is to illustrate the surgical technique of a minimally invasive thoracoscopic approach to the anterolateral thoracolumbar spine and to discuss its potential indications and contraindications in patients with diseases involving the anterior thoracic and lumbar regions.

Since the introduction of thoracoscopic surgery by Jacobaeus[15] in 1910, the technique has undergone enormous advances. With the development of high-quality video imaging, small endoscopes, and modified new instruments, video-assisted thoracic surgery has become the minimally invasive technique of choice for most thoracic and transthoracic surgeries. As our experience and success with video-assisted thoracic surgery has grown, surgeons have recently begun to apply the technique to thoracic spine surgery.[1,16,23,30,31]

Traditionally, thoracolumbar diseases in need of surgery required an open thoracotomy or a thoracoabdominal exposure of both the thoracic cavity and the retroperitoneal space. Alternatively, a retropleural thoracotomy or a lateral extracavitary approach was used to gain access to the anterior thoracic or lumbar spine.[2,6,12,29] These open approaches require extensive incisions, muscle dissection, and rib resections to provide adequate surgical exposure of the anterior thoracolumbar spine. In 1993, Mack, et al.,[18] first reported their experience of thoracoscope-assisted spine surgery. This was followed by the report by McAfee, et al.,[21] which described the safety and potential complications of thoracoscopic and laparoscopic surgery for the anterior thoracolumbar spine. In 2002, Khoo, et al.,[16] reported the outcome of thoracoscopic spine surgery in 371 trauma patients with thoracolumbar fractures. Today, the indications for thoracoscopic anterior spine surgery have expanded enormously to include spinal biopsy procedures, debridement, discectomy, decompressive corpectomy, interbody fusions, and internal fixations.

Minimal access surgical techniques can potentially decrease spinal access morbidity and speed recovery and healing.[4,7,16,17] At the University of Utah Medical Center, we have performed 30 thoracoscopic spine surgeries for thoracolumbar trauma, tumors, and infection. The purpose of this article is to review the surgical technique, indications, and contraindications of a minimally invasive thoracoscopy-assisted approach to the thoracolumbar spine.