Abstract
The rapid expansion of minimally invasive techniques for corpectomy in the thoracic spine provides promise to redefine treatment options in this region. Techniques have evolved permitting anterior, lateral, posterolateral, and midline posterior corpectomy in a minimally invasive fashion. We review the numerous techniques that have been described, including thoracoscopy, tubular retraction, and various instrumentation techniques. Minimally invasive techniques are compared to their open predecessors from a technical and complication standpoint. Advantages and disadvantages of different approaches are also considered, with an emphasis on surgical strategies and nuance.
Highlights
The unique anatomy and structural support in the thoracic spine create challenges for practitioners attempting surgery in the region
Used initially primarily in the treatment of thoracic disc herniation, it found significant popularity in the 1970s and 1980s in response to the disappointing results for laminectomy for decompression and discectomy, due to poor outcomes associated with manipulation of the thoracic spinal cord [1, 6, 17,18,19]
Video-assisted thoracoscopy has allowed surgeons to avoid much of the incision- and dissection-related morbidity associated with thoracotomy [11, 20, 21]
Summary
The unique anatomy and structural support in the thoracic spine create challenges for practitioners attempting surgery in the region. The most common pathologies in the thoracic spine requiring corpectomy are tumors, trauma, and infection [2,3,4]. Treating these pathologies can require significant anterior reconstruction, made challenging due to the ribs and other adjacent critical structures including the lungs, pleura, aorta, and mediastinum [5]. Their advent is allowing surgeons to consider treatment for patients who previously would have been relegated to bracing and palliative pain relief due to risks of open surgery. We present here the treatment options described in the literature, with an emphasis on specific advantages, disadvantages, and surgical nuance (Table 1)
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