Tj. Huang et al., VIDEO-ASSISTED THORACOSCOPIC TREATMENT OF SPINAL LESIONS IN THE THORACOLUMBAR JUNCTION, Surgical endoscopy, 11(12), 1997, pp. 1189-1193
Background: The endoscopic treatment of spinal lesions in the thoracol
umbar junction (T11-L2) poses a great challenge to the surgeon. From N
ovember 1, 1995 to December 31, 1996, we successfully used a combinati
on of video-assisted thoracoscopy and conventional spinal instruments
to treat 38 patients with anterior spinal lesions. Twelve of them had
lesions in the thoracolumbar junction. Methods: The so-called extended
manipulating channel method was used to perform vertebral biopsy, dis
cectomy, decompressive corpectomy, interbody fusions, and/or internal
fixations in these patients. The size of the thoracoscopic portals was
greater than usual in order to allow conventional spinal instruments
and a thoracoscope to enter the chest cavity freely and be manipulated
by techniques similar to those used in standard open surgical procedu
res. In this series, the procedures were performed by using either a t
hree-portal approach (2.5-3.5 cm) or a modified two-portal technique i
nvolving a 5-6 cm larger incision and a small one for introducing the
scope. Results: None of the operations resulted in injury to the great
vessels, internal organs, or spinal cord. The total time for the oper
ation ranged from 1.5 to 4.5 h (average, 3); and the total blood loss
ranged from 50 to 3000 cc (average, 1050). One patient was converted t
o an open procedure due to severe pleural adhesion. Complications incl
uded two instances of transient intercostal neuralgia, one superfical
wound infection, and one residual pneumothorax. Conclusions: The video
-assisted technique with the extended manipulating channel method pres
ented in this report simplifies thoracoscopic spinal surgery in the th
oracolumbar junction and makes it easier. It avoids division of the di
aphragm, removal of the rib, and wide spread of the intercostal space,
and it allows greater control of intraoperative vessel bleeding. Usin
g this technique, the number of portals required during the procedure
can be reduced. In addition, the technique reduces the endoscopic mate
rials required, thus lowering overall cost. It is an effective and pro
mising approach.