Circumferential Spinal Cord Decompression Through a Posterior Midline Approach With Lateral Auxiliary Ports for Lower Thoracic Compressive Myelopathy

Abstract

The lower thoracic spine is a complicated area within the vertebral column because of its anatomic complexity and inaccessibility. A variety of surgical procedures have been applied to access lower thoracic spinal lesions. When hard compressive pathologies are located on the ventral side of the dura, existing surgical approaches have limitations and often have poor outcomes. To describe a new operative technique, modified posterior laminectomy, and report the results of 3 consecutive cases. First, posterior decompression was performed by laminectomy. The cutting burr was introduced to make a hole in the lateral vertebral body, and this hole was deepened and extended to make a cavity into the vertebra. Next, ventral dural decompression was performed using a posterior approach with lateral auxiliary ports. A lateral auxiliary port was made about 10 to 12 cm away from the midline and dilated toward the midline in a diagonal fashion. The cutting burr was inserted along the port and used for further drilling out. An opposite port was made, and the same procedure was repeated until both sides were in communication. The compressive lesion was then dissected and removed with minimal retraction of the dural sac. Finally, the corresponding segments were stabilized. Complete removal of the lesion was achieved in all 3 patients without neurological deterioration or surgery-related complications. Circumferential decompression through a posterior approach with lateral auxiliary ports is simple and easy to apply with posterior laminectomy. This new operative technique is a safe, effective, and less invasive approach to ventral dural compressive lesions in the lower thoracic region.