Spinal cord decompression by minimally invasive transthoracic lateral approach. Case report

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Augusto Esteban Martínez
Felipe Jose Lanari Subiaur
Carlos María Mounier
José Ricardo Prina
Ramiro Gutiérrez
Enrique Augusto Gobbi

Abstract

There are multiple techniques for spinal cord decompression in the thoracic spine, each with its advantages and disadvantages, and requiring different surgical skills. Recently, minimally invasive techniques have been developed, reducing morbidity rates and achieving good functional results.
We present the case of a 64-year-old male with spinal compression symptoms, central disc herniation calcified at the fifth thoracic vertebra, which migrated to the lower end of the sixth thoracic vertebra. Diagnosis was clear for spinal cord compression. Partial posterior corpectomy of the sixth vertebra was performed with a minimally invasive transthoracic transpleural lateral approach and without additional fixation. The patient had a good outcome on follow-up, without progression of neurological symptoms or residual rib pain.
Minimally invasive lateral approaches are valid techniques for the treatment of compression disorders of the thoracic spine, with low rates of morbidity and mortality, and a rapid recovery.

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How to Cite
Martínez, A. E., Lanari Subiaur, F. J., Mounier, C. M., Prina, J. R., Gutiérrez, R., & Gobbi, E. A. (2019). Spinal cord decompression by minimally invasive transthoracic lateral approach. Case report. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(1), 70-74. https://doi.org/10.15417/issn.1852-7434.2019.84.1.833
Section
Case Presentations
Author Biographies

Augusto Esteban Martínez, CEMIC, Ciudad Autónoma de Buenos Aires

Servicio de Ortopedia y Traumatología, Unidad de Patología de Columna Vertebral, CEMIC, Ciudad Autónoma de Buenos AiresBeca de perfeccionamiento en cirugia espinal

Felipe Jose Lanari Subiaur, Grupo Médico Vertebral, Ciudad Autónoma de Buenos Aires

Grupo Médico Vertebral, Ciudad Autónoma de Buenos Aires

Carlos María Mounier, CEMIC, Ciudad Autónoma de Buenos Aires

Jefe de Servicio de Ortopedia y Traumatología en el Instituto Nacional de Rehabilitación Psicofísica: Buenos Aires, Argentina

José Ricardo Prina, Grupo Médico Vertebral, Ciudad Autónoma de Buenos Aires

Grupo Médico Vertebral, Ciudad Autónoma de Buenos Aires

Ramiro Gutiérrez, Grupo Médico Vertebral, Ciudad Autónoma de Buenos Aires

Grupo Médico Vertebral, Ciudad Autónoma de Buenos Aires

Enrique Augusto Gobbi, CEMIC Grupo Médico Vertebral

Grupo Médico Vertebral, Ciudad Autónoma de Buenos Aires

References

1. Louge V. Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 1952;15(4):227-41. DOI:10.1136/jnnp.15.4.227

2. Arseni C, Nash F. Thoracic intervertebral disc protrusion: a clinical study. J Neurosurg 1960;17:418-30.
DOI: 10.3171/jns.1960.17.3.0418

3. Hulme A. The surgical approach to thoracic intervertebral disc protrusions. J Neurosurg Psychiatry 1960;23:133-7. Doi: 10.1136/jnnp.23.2.133

4. Le roux PD, Haglund MM, Harris AB. Thoracic disc disease: experience with the transpedicular approach in twenty
consecutive patients. Neurosurgery 1993;33:58-66. DOI:10.1097/00006123-199307000-00009

5. Perot Jr PL, Munro DD. Transthoracic removal of midline thoracic disc protrusions causing spinal cord compression. J Neurosurg 1969;31:452-8. DOI:10.3171/jns.1969.31.4.0452

6. Rosenthal D, Rosenthal R, de Simone A. Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine 1994;19(9):1087-91. DOI: 10.1097/00007632-199405000-00018

7. Dakwar E, Ahmadian A, Uribe JS. The anatomical relationship of the diaphragm to the thoracolumbar junction during the minimally invasive lateral extracelomic (retropleural/retroperitoneal) approach. J Neurosurg Spine 2012;16:359-64.
DOI: 10.3171/2011.12.SPINE11626

8. Uribe JS, Smith WD, Pimenta L, Hartl R, Dakwar E, Modhia UM. Minimally invasive lateral approach for symptomatic thoracic disc herniation: initial multi-center clinical experience. J Neurosurg Spine 2012;16:264-79. DOI: 10.3171/2011.10.SPINE11291

9. Karmakar MK, Ho AM. Postthoracotomy pain syndrome. Thora Surg Clin 2004;14:345-52. DOI:10.1016/S1547-4127(04)00022-2

10. Hann PP, Kenny K, Dickman CA. Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures. Neurosurgery 2002;52(Suppl 5):88-95. DOI:10.1097/00006123-200211002-00013

11. McAfee PC, Regan JR, Zdeblick T, Zuckerman J, Picetti GD 3rd, Heim S, et al. The incidence of complications in endoscopic anterior thoracolumbar spinal reconstructive surgery. A prospective multicenter study comprising the first 100 consecutive cases. Spine (Phila PA 1976) 1995;20:1624-32. DOI:10.1097/00007632-199507150-00012

12. Deviren V, Kuelling FA, Poulter G, Pekmezci M. Minimal invasive anterolateral transthoracic transpleural approach: a novel technique for thoracic disc herniation. A review of the literature, description of a new surgical technique and experience with first 12 consecutive patients. J Spinal Disord Tech 2011;24:E40-8.
DOI: 10.1097/BSD.0b013e318220af6f

13. Nacar OA, Ulu MO, Pekmezci M, Deviren V. Surgical treatment of thoracic disc disease via minimally invasive lateral transthoracic trans/retropleural approach: analysis of 33 patients. Neurosurg Rev 2013;36:455-65. DOI: 10.1007/s10143-013-0461-2

14. Uribe JS, Dakwar E, Le TV, Christian G, Serrano S, Smith WD. Minimally invasive surgery treatment for thoracic spine tumor removal: a mini-open, lateral approach. Spine 2010;35:S347-54. DOI: 10.1097/BRS.0b013e3182022d0f

15. White AA III, Panjabi MM. Clinical biomechanics of the spine, 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 1990. ISBN-10: 0397507208