Article
Tubular retractor-assisted retropleural approach for thoracic disc herniation
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Published: | June 18, 2018 |
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Objective: Thoracic disc herniations are surgically addressed using thoracotomy, costotransversectomy or transpedicular approaches with different but in most cases considerable morbidities. Here we describe a new tubular retractor-assisted retropleural approach to the thoracic spine which allows for microsurgical exploration of thoracic disc herniations.
Methods: Patients position was lateral (with the side of disc herniation facing up). A 3 cm skin incision was performed approximately 12 cm paramedian on the ipsilateral side to the index level. The lower rib to the skin incision was partially resected using diamond drill or punches. Retropleural dissection and exposure of the head of the lower rib and the neuroforamen was performed using a short apnea and deflating of the ipsilateral lung. Thereafter, a tubular retractor was positioned over the disc and neuroforamen. Using microsurgical technique a part of the lower head of the rip and the posterior lateral part of the index disc was removed to assess the disc herniation.
Results: Excellent microsurgical exposure of the disc and neural structures form an antero-lateral direction was assessed using a minimal invasive opening without the need for thoracotomy and permanent lung deflation (Figure 1 [Fig. 1]).
Conclusion: The retropleural approach using a tubular retractor system allows for excellent microsurgical exposure to the anterior lateral thoracic spinal canal.