What is thoracic spine surgery?

Thoracic spine surgery involves a variety of procedures aimed at addressing different conditions affecting the thoracic spine. Advances in surgical techniques have led to the increasing use of minimally invasive approaches in thoracic spine surgeries. These techniques include thoracoscopic surgery, endoscopic spine surgery, and minimally invasive posterior fusion procedures (Mack et al., 1996; Shen et al., 2021; Smith et al., 2008). Thoracoscopic surgery enables anterior approaches in procedures such as diskectomy, spinal deformity correction, and corpectomy (Mack et al., 1996). Endoscopic spine surgery techniques have progressed over time, with applications expanding to the thoracic spine, providing less invasive options like posterior thoracic unilateral laminectomy and bilateral decompression (Shen et al., 2021). Minimally invasive posterior fusion procedures have been developed to treat thoracic spine diseases, with adaptations from thoracoscopic techniques (Smith et al., 2008).

The utilization of endoscopic techniques, including thoracic discectomy and decompression, has become popular in treating thoracic spine disorders (Hur et al., 2023). These techniques have demonstrated success in managing conditions such as thoracic myelopathy caused by ossification of the ligamentum flavum (Baba et al., 2020). Furthermore, endoscopic surgeries have extended not only to the lumbar spine but also to the thoracic and cervical spines (Heo et al., 2021). Challenges like wrong-level surgery in the thoracic spine have been mitigated through techniques such as preoperative fiducial screw placement for accurate localization (Upadhyaya et al., 2012).

Complications in thoracic spine surgery, such as unplanned reoperations, have been linked to factors like thoracic kyphosis and intraoperative dural injury (Hu et al., 2022). Additionally, adjacent-segment disease after thoracic pedicle screw fixation has been identified as a potential issue in fusion surgery (Agarwal et al., 2018). Rare complications like thoracic duct injury and chylothorax can occur in anterior spine procedures, underscoring the importance of meticulous surgical approaches (Akçalı et al., 2006).

In conclusion, thoracic spine surgery encompasses a spectrum of procedures that have evolved to include minimally invasive and endoscopic techniques. While these advancements offer benefits such as reduced invasiveness and improved patient outcomes, challenges like complications and the need for precise localization remain crucial considerations in ensuring the success of thoracic spine surgeries.

References #

1. Agarwal, N., Heary, R., & Agarwal, P. (2018). Adjacent-segment disease after thoracic pedicle screw fixation. Journal of Neurosurgery Spine, 28(3), 280-286. https://doi.org/10.3171/2017.6.spine1492
2. Akçalı, Ö., Kiray, A., Ergur, I., Tetik, S., & Alıcı, E. (2006). Thoracic duct variations may complicate the anterior spine procedures. European Spine Journal, 15(9), 1347-1351. https://doi.org/10.1007/s00586-006-0082-3
3. Baba, S., Shiboi, R., Yokosuka, J., Oshima, Y., Takano, Y., Iwai, H., … & Koga, H. (2020). Microendoscopic posterior decompression for treating thoracic myelopathy caused by ossification of the ligamentum flavum: case series. Medicina, 56(12), 684. https://doi.org/10.3390/medicina56120684
4. Heo, D., Lee, J., Kim, H., & Chung, H. (2021). Recent trends and changes in the endoscopic spinal surgery. Journal of Minimally Invasive Spine Surgery and Technique, 6(Suppl 1), S81-S83. https://doi.org/10.21182/jmisst.2021.00136
5. Hu, Y., Ouyang, H., Yang, K., Qi, J., Dong, Y., Peng, X., … & Tian, Y. (2022). Thirty-day unplanned reoperations after posterior surgery for thoracic spinal stenosis: a single-center study based on 1948 patients. Spine, 48(7), 507-513. https://doi.org/10.1097/brs.0000000000004499
6. Hur, J., Lee, S., Kim, B., & Kim, S. (2023). The growing popularity of miss: a focus on endoscopic surgery for the cervical and thoracic spine. Journal of Minimally Invasive Spine Surgery and Technique, 8(1), 5-8. https://doi.org/10.21182/jmisst.2023.00766
7. Mack, M., Regan, J., & Landreneau, R. (1996). Thoracoscopic surgery of the spine. Surgical Innovation, 3(4), 253-258. https://doi.org/10.1177/155335069600300407
8. Shen, J., Shaaya, E., Bae, J., & Telfeian, A. (2021). Endoscopic spine surgery of the cervicothoracic spine: a review of current applications. The International Journal of Spine Surgery, 15(suppl 3), S93-S103. https://doi.org/10.14444/8168
9. Smith, J., Ogden, A., & Fessler, R. (2008). Minimally invasive posterior thoracic fusion. Neurosurgical Focus, 25(2), E9. https://doi.org/10.3171/foc/2008/25/8/e9
10. Upadhyaya, C., Wu, J., Chin, C., Balamurali, G., & Mummaneni, P. (2012). Avoidance of wrong-level thoracic spine surgery: intraoperative localization with preoperative percutaneous fiducial screw placement. Journal of Neurosurgery Spine, 16(3), 280-284. https://doi.org/10.3171/2011.3.spine10445