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.
KeywordsMinimally invasive spine surgery (MISS) Thoracic spine Thoracic trauma Thoracic surgery
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