Thoracic decompression

Treatment of a thoracic disc herniation is limited by the inability to retract the thoracic spinal cord without causing neurologic deficits. Traditional posterior decompression has been ineffective, but surgeons have had success with a posterolateral, lateral, or anterior surgical technique. When approaching from the lateral or anterior trajectory, surgical considerations become complicated with consideration of the ribs, underlying pleura and lung, mediastinum, and heart. The goal of minimally invasive spine surgery (MISS) in the thoracic spine is to provide direct access to the pathology with minimal disruption of the normal anatomic structures to minimize long-term patient morbidity. MISS approaches have been shown to be safe for cervical and lumbar decompression, tumor resection, and stabilization of the spine. These techniques have been applied to thoracic spine pathology as well: MISS posterolateral approach for paracentral thoracic discectomy and MISS lateral extracavitary approach for thoracic corpectomy. In the thoracic spine, MISS patients have similar outcomes as traditional surgical patients with a decrease in clinically significant morbidity.