Skip to main content
Log in

Oblique paraspinal approach for thoracic disc herniations using tubular retractor with robotic holder: a technical note

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Introduction

Symptomatic thoracic disc herniations (TDHs) are uncommon and can be surgically treated. Although transthoracic decompression is considered the gold standard, it is associated with significant comorbidities. In particular, approach via a posterior laminectomy has been associated with poor results. Several strategies have been developed for the resection of TDHs without manipulating the spinal cord. We describe a minimally invasive technique by using 3-D navigation and tubular retractors with the aid of a robotic holder via an oblique paraspinal approach.

Materials and Methods

The 20-mm working tube via an oblique trajectory through the fascia provides a good surgical field for thoracic discectomy through a microscope. We present our first five patients with TDHs operated using this minimally invasive approach.

Results

Neurological symptoms were improved postoperatively, and there were no surgical complications. There was no instability or recurrence during the follow-up period.

Conclusion

The oblique paraspinal approach may offer an alternative surgical option for treating TDHs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Okada Y, Shimizu K, Ido K, Kotani S (1997) Multiple thoracic disc herniations: case report and review of the literature. Spinal Cord 35:183–186

    Article  PubMed  CAS  Google Scholar 

  2. Awwad EE, Martin DS, Smith KR Jr, Baker BK (1991) Asymptomatic versus symptomatic herniated thoracic discs: their frequency and characteristics as detected by computed tomography after myelography. Neurosurgery 28:180–186

    Article  PubMed  CAS  Google Scholar 

  3. Benjamin V (1983) Diagnosis and management of thoracic disc disease. Clin Neurosurg 30:577–605

    PubMed  CAS  Google Scholar 

  4. Stillerman CB, Weiss MH (1992) Management of thoracic disc disease. Clin Neurosurg 38:325–352

    PubMed  CAS  Google Scholar 

  5. Bohlman HH, Zdeblick TA (1988) Anterior excision of herniated thoracic discs. J Bone Joint Surg Am 70:1038–1047

    PubMed  CAS  Google Scholar 

  6. Dietze DD, Fessler RG (1993) Thoracic disc herniations. Neurosurg Clin N Am 4:75–90

    PubMed  Google Scholar 

  7. Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH (1998) Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg 88:623–633

    Article  PubMed  CAS  Google Scholar 

  8. Rossitti S (1994) Modified lateral approach for surgery of thoracic disk herniation. Technical note. Arq Neuropsiquiatr 52:227–230

    Article  PubMed  CAS  Google Scholar 

  9. Fessler RG, Dietze DD Jr, Millan MM, Peace D (1991) Lateral parascapular extrapleural approach to the upper thoracic spine. J Neurosurg 75:349–355

    Article  PubMed  CAS  Google Scholar 

  10. Stillerman CB, Chen TC, Day JD, Couldwell WT, Weiss MH (1995) The transfacet pedicle-sparing approach for thoracic disc removal: cadaveric morphometric analysis and preliminary clinical experience. J Neurosurg 83:971–976

    Article  PubMed  CAS  Google Scholar 

  11. Bilsky MH (2000) Transpedicular approach for thoracic disc herniations. Neurosurg Focus 9:e3

    Article  PubMed  CAS  Google Scholar 

  12. Patterson RH, Arbit E (1978) A surgical approach through the pedicle to protruded thoracic discs. J Neurosurg 48:768–772

    Article  PubMed  Google Scholar 

  13. Simpson JM, Silveri CP, Simeone FA, Balderston RA, An HS (1993) Thoracic disc herniation. Re-evaluation of the posterior approach using a modified costotransversectomy. Spine (Phila Pa 1976) 18:1872–1877

    Article  CAS  Google Scholar 

  14. Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR (2010) Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. J Neurosurg Spine 12:221–231

    Article  PubMed  Google Scholar 

  15. Choi KY, Eun SS, Lee SH, Lee HY (2010) Percutaneous endoscopic thoracic discectomy; transforaminal approach. Minim Invasive Neurosurg 53:25–28

    Article  PubMed  CAS  Google Scholar 

  16. Haufe SM, Mork AR, Pyne M, Baker RA (2010) Percutaneous laser disc decompression for thoracic disc disease: report of 10 cases. Int J Med Sci 7:155–159

    Article  PubMed  Google Scholar 

  17. Arce CA, Dohrmann GJ (1985) Herniated thoracic disks. Neurol Clin 3:383–392

    PubMed  CAS  Google Scholar 

  18. Black P (2000) Laminotomy/medial facet approach in the excision of thoracic disc herniation. Neurosurg Focus 9:e6

    PubMed  CAS  Google Scholar 

  19. Wiltse LL, Bateman JG, Hutchinson RH, Nelson WE (1968) The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am 50:919–926

    PubMed  CAS  Google Scholar 

  20. Kim JS, Lee SH, Moon KH, Lee HY (2009) Surgical results of the oblique paraspinal approach in upper lumbar disc herniation and thoracolumbar junction. Neurosurgery 65:95–99 (discussion 99)

    Article  PubMed  Google Scholar 

  21. Moon KH, Lee SH, Kong BJ, Shin SW, Bhanot A, Kim DY, Lee HY (2006) An oblique paraspinal approach for intracanalicular disc herniations of the upper lumbar spine: technical case report. Neurosurgery 59:ONSE487–ONSE488 (discussion ONSE488)

    Article  PubMed  Google Scholar 

  22. Khoo LT, Smith ZA, Asgarzadie F, Barlas Y, Armin SS, Tashjian V, Zarate B (2011) Minimally invasive extracavitary approach for thoracic discectomy and interbody fusion: 1-year clinical and radiographic outcomes in 13 patients compared with a cohort of traditional anterior transthoracic approaches. J Neurosurg Spine 14:250–260

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ho-Yeon Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cho, J.Y., Lee, SH., Jang, S.H. et al. Oblique paraspinal approach for thoracic disc herniations using tubular retractor with robotic holder: a technical note. Eur Spine J 21, 2620–2625 (2012). https://doi.org/10.1007/s00586-012-2438-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2438-1

Keywords

Navigation