Outcomes and Complications of 179 Thoracoscopic Approaches to the Thoracic Spine

Patrick P Han, MD
Paul W Detwiler, MS, MD
Randall W Porter MD
Curtis A. Dickman, MD

Introduction:

Microsurgical thoracoscopic approaches to the thoracic spine allow neurosurgeons to access the disc spaces, vertebral bodies, paravertebral soft tissues, spinal cord, spinal nerves, and sympathetic chain with minimal invasiveness.

Methods:

Between 1994 and 1999, 179 thoracoscopic cases were performed: 130 thoracic sympathectomies, 38 discectomies, 5 resections of neurogenic tumors, 4 corpectomies and spinal reconstructions, and 2 biopsies. Charts were reviewed retrospectively and prospectively to evaluate the efficacy and complications of the thoracoscopic procedures.

Results:

No patient died, and 18 complications, 5 (2.8%) of which were permanent, occurred. The complications were as follows: Horner's syndrome, 4; transient intercostal neuralgia, 4; pneumonia, 2; pneumothorax requiring chest tube, 2; pleural effusion, 2; chronic hemothorax, 1; persistent radicular pain, 1; paraparesis, 1; and respiratory insufficiency, 1.

Conclusion:

Thoracoscopic spine surgery can be efficacious with a lower morbidity rate than that of thoracotomy and still provide full, direct access to the ventral thoracic spine. It appears to improve patient comfort and cosmetic results and shorten the length of hospitalization and recovery times. This technique has become the senior author's surgical approach of choice to remove intrathoracic benign neurogenic tumors and central, herniated thoracic discs and to perform thoracic syrnpathectomies. The senior author still prefers open thoracotomy for most thoracic corpectomies associated with spinal reconstruction.