THORACOSCOPIC APPROACHES TO THE THORACIC SPINE

Microsurgical approaches for the treatment of pathology located in the ventral thoracic spine using video-assisted thoracic surgery (VATS) a llow neurosurgeons to access the disc spaces, vertebral bodies, parave rtebral soft tissues, spinal cord, spinal nerves, and sympathetic chai n with minimally invasive surgery. This has been associated with subst antial clinical benefits including reduced postoperative pain, lower c omplication rates and shorter recovery times when compared with standa rd thoracotomy techniques. This article describes the experience at ou r institution with VATS for discectomy (20 cases), corpectomy and spin al reconstruction (8 cases), thoracic sympathectomy (3 cases), and ner ve sheath tumor removal (1 case). The technique can be mastered but re quires surgeons to learn the new psychomotor skills needed to perform endoscopic spine surgery. The learning curve is steep. Special trainin g in instructional seminars, surgical skill laboratories, and clinical preceptorships is needed before this surgical approach can be used cl inically to treat spinal pathology. VATS has significant advantages co mpared to standard thoracotomy, including reduced incisional pain and avoidance of the postthoracotomy pain syndrome. If intercostal neuralg ia develops postoperatively, it is milder and usually transient compar ed to the pain associated with standard thoracotomy. Better cosmetic o utcomes, earlier mobilization, and faster recovery are added benefits. The surgical techniques are relatively new for neurosurgeons and requ ire dedicated practice to master them. Once the surgical skills are pe rfected, VATS is feasible for spinal pathology and can be performed sa fely and effectively.