Thoracoscopically assisted ligamentous release of the thoracic spine: a cadaver study

The surgical treatment of thoracic kyphosis frequently requires an anterior release, which can be carried out by an open or endoscopic technique. This study concerns the reference points which are essential from the anatomic view for minimizing the operative risks. Furthermore we wanted to find the most convenient video-assisted thoracoscopic surgery (VATS) technique for t ransection of the anterior longitudinal ligament (ALL). Transection of the ALL, as well as discectomy, was performed using this technique. The extensi ve anatomic dissection of 12 fresh cadavers was performed to define possibl e technical errors and surgical complications. The development of new instr uments has made the VATS approach to the ALL a viable alternative to open p rocedures. With the help of a standardized technique, the isolated thoracos copic ligamentous transection required less time than the comparable open p rocedure. The anatomic study showed, that in no case was a ligation of the intercostal or segmental vessels necessary as part of the approach to the s pine, once an adequate mobilization of the esophagus and azygos vein had be en carried out. The risk of an ischemic lesion of the spinal cord was there by reduced. The thoracoscopic, limited anterior release consisting of a mul tilevel transection of the ALL proved to be a rapid and reliable procedure. Our anatomic studies provides suitable the reference points.