Thoracic decompression

Prior to the development of minimally invasive surgery (MIS), thoracic spine pathology was surgically addressed using an open anterior approach through the mediastinum which was associated with high surgical morbidity. If a less invasive surgical approach was desired, a posterior decompression was often done; but this was also found to be ineffective, as the thoracic cord could not be manipulated due to the high risk of neurologic injury. The development of spine techniques utilizing MIS has expanded the treatment options for thoracic cord pathology while decreasing morbidity and blood loss. The goal of MIS is to minimize disruption of normal surgical anatomy to minimize patient morbidity. Several MIS methods have been developed to address pathologies including decompression, stabilization, and tumor resection. MIS approaches developed include the transpedicular, the posterolateral (costotransversectomy), and the lateral extracavitary approach. In this chapter, we discuss the clinical presentation, surgical considerations, and techniques when surgically treating thoracic spine disease. Clinically significant morbidity has decreased when using MIS approaches to the thoracic spine.