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Thoracoscopic Fusion

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Minimally Invasive Spine Surgery

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Abstract

Thoracoscopic spinal fusion procedures represent a minimally invasive alternative to conventional open transthoracic operations. A broad spectrum of pathologies, including degenerative, traumatic, and tumor conditions, can be managed with this technique. Several instrumentation devices have also been introduced to match the challenges of an endoscopic anterior approach including special screw-plate systems as well as expandable cages.

Preoperative planning involving choosing the most appropriate side for the approach, correct patient positioning, as well as portal placements are determining factors for the overall success of the operation.

Great care must be taken during soft tissue dissection to avoid larger vessel or lung injury. In order to visualize the lateral wall of the vertebrae, the attached rib heads have to be resected and can later be used as an interbody construct.

Discectomies in the lower thoracic spine often require instrumentation, which can be accomplished with plate and double-rod constructs. Corpectomy sites always need to be reconstructed. Expandable cages combined with anterolateral fixation devices are most widely used for this purpose.

The most common complications of thoracoscopic procedures involve the respiratory system due to single-lung ventilation and lung tissue retraction. Conversion to an open approach is always a possibility as intraoperative complications occur.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA

    Rodrigo Navarro-Ramirez, Christoph Wipplinger, Sertac Kirnaz, Eliana Kim & Roger Härtl

Authors
  1. Rodrigo Navarro-Ramirez
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  2. Christoph Wipplinger
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  3. Sertac Kirnaz
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  4. Eliana Kim
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  5. Roger Härtl
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Corresponding author

Correspondence to Roger Härtl .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

  2. Texas Back Institute Texas Health Presbyterian Hospital Plano Scoliosis and Spine Tumor Center, Plano, TX, USA

    Isador H. Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

  1. 1.

    Mention at least two indications for the thoracoscopic approach.

  2. 2.

    Mention at least two contraindications for the thoracoscopic approach.

  3. 3.

    What is the recommended bone graft for thoracic corpectomies?

  4. 4.

    How are intraoperative CSF leaks of the thoracic spine treated?

  5. 5.

    What should junior surgeons do when performing thoracoscopic surgery?

Answers

  1. 1.

    Spinal cord compression after thoracic disc herniation

    Compromised anterior column secondary to vertebral fracture

  2. 2.

    Previous lung injury

    Acute lung failure

  3. 3.

    Tricortical bone graft/titanium cages filled with autologous bone graft

  4. 4.

    Tailored management is necessary. Chest tube suction may need special attention

  5. 5.

    Be supported by a senior surgeon until technical familiarity is obtained

    Be aware that all personnel in the OR need special instruction and knowledge about the procedure, as well as potential incidents/complications and how to address them

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Navarro-Ramirez, R., Wipplinger, C., Kirnaz, S., Kim, E., Härtl, R. (2019). Thoracoscopic Fusion. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_28

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  • DOI: https://doi.org/10.1007/978-3-030-19007-1_28

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19006-4

  • Online ISBN: 978-3-030-19007-1

  • eBook Packages: MedicineMedicine (R0)

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