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Case Reports
. 2012 Dec;21(12):2620-5.
doi: 10.1007/s00586-012-2438-1. Epub 2012 Jul 24.

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

Ji Young Cho  1 , Sang-Ho Lee, Sang Hoon Jang, Ho-Yeon Lee
Affiliations
Case Reports

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

Ji Young Cho et al. Eur Spine J. 2012 Dec.

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.

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Figures

Fig. 1
Fig. 1
A 2-cm tubular retractor was inserted using the oblique paraspinal approach (a). A robotic arm was provided for stiffer angle (b)
Fig. 2
Fig. 2
A tubular retractor placed at the lateral part of the facet joint between transverse processes
Fig. 3
Fig. 3
An intraoperative photograph showing the dura (*) and exiting nerve root (**). The herniated disc particle was removed after gentle dissection
Fig. 4
Fig. 4
MR images revealed a T7–8 disc herniation (a). A left paracentral disc herniation causes marked spinal cord compression at the coronal image (b)
Fig. 5
Fig. 5
Sagittal T2-weighted MRI image showing a thoracic disc herniation at T8–9 with cord compression (a). Axial slice CT scans of T8–9 soft disc herniation (b). A postoperative T2-weighted axial MRI scan showing complete decompression of the T8–9 disc herniation (c) MRI scan obtained on postoperative day 1
See this image and copyright information in PMC

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