Minimally Invasive Transpedicular Approach with Stereotactic Navigation for Evacuation and Fusion of Thoracic Ventral Epidural Abscess of Thoracic Spine: an illustrative case

Abstract

Background: Surgical treatment of ventral thoracic pathologies can be challenging due to anatomical restrictions limiting corridor access, need for extensive spinal cord manipulation and limited experience for most spine surgeons’ due rarity of ventral thoracic pathologies. There is growing evidence that creation of a ventrolateral operative corridor through minimal invasive (MIS) transpedicular approach is safe and effective for accessing and treating of ventral thoracic spinal lesions [ 1-6] However, poor visualization with difficulty of spinal cord manipulation due to tubular retractor restriction remains changeling for MIS transpedicular approach. Objective: The authors illustrate a case of concurrent utilization of MIS tubular approach and stereotactic navigation to ensures safe and effective removal of epidural abscess and subsequent fusion. Conclusion: Addressing any lesion located anteriorly to the dentate ligament can be challenging and often necessitates either an antero-lateral or an anterior approach. This choice may depend on various factors, including the availability of an access surgeon. Utilization of stereotactic navigation with MIS transpedicular approach for ventral thoracic lesions, allows for real time intraoperation localization and visualization increasing lesion targeting accuracy and less cord manipulation. It also provides immediate post instrumentation checks and less radiation exposure for operating personals.