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Video-Assisted Thoracoscopic Surgery Combined With a Tubular Retractor System for Minimally Invasive Thoracic Discectomy

Yanni, Daniel S MD*; Connery, Cliff MD†; Perin, Noel I MD, FRCS(E)‡

doi: 10.1227/NEU.0b013e318209348c
Operative Technique

BACKGROUND: Several approaches have been proposed for the treatment of thoracic disc herniations. Posterior approaches include transpedicular, costotransversectomy, and lateral extracavitary; anterior approaches include retropleural and transpleural thoracotomy and thoracoscopy.

OBJECTIVE: We present a novel minimally invasive approach to thoracic discectomies, combining thoracoscopy and a tubular retractor system. We discuss the utility and safety of this technique.

METHODS: The patient is placed in a lateral decubitus position, with a double-lumen endotracheal tube for single-lung ventilation. With use of thoracoscopic techniques, the disc space is identified; approximately 2 cm of the head and neck of the rib is removed to expose the pedicle of the lower vertebral body. The tubular retractor is deployed with continuous thoracoscopic visualization and a trough is created anterior to the canal by drilling the adjacent vertebral bodies straddling the disc space. The operative microscope is utilized to dissect the disc, pulling it anteriorly into the trough.

RESULTS: There were 5 patients in the past 9 months who were candidates for anterior thoracic discectomy. Disc herniations from T3-4 to T10-11 were treated without any significant complications. Patients were followed up clinically and radiographically.

CONCLUSION: Combining thoracoscopy with the tubular retractors allows continuous monitoring of the lung, aorta, and vena cava during the placement of the retractors. Additionally, use of the tubular retractors, as opposed to a complete thoracoscopic discectomy reduces the working distance and allows the use of the microscope with 3-dimensional visualization, thus enhancing the safety of this approach.

*Department of Neurosurgery, University of California, Irvine Medical Center, Irvine, California; †St. Luke's, Roosevelt Medical Center, Department of Thoracic Surgery, New York, New York; and ‡Department of Neurosurgery, NYU Medical Center, New York, New York

Received, April 20, 2009.

Accepted, October 1, 2010.

Correspondence: Noel I. Perin, MD, FRCS(E) Department of Neurosurgery, 530 1st Avenue, Suite 8-S, New York, NY 10016. E-mail:

Copyright © by the Congress of Neurological Surgeons