Thorascopic Spinal Surgery
Thoracic disc Herniation
Large central or calcific disc herniations requiring an antero-lateral thoracotomy approach, from T2-3 to T12-L1 can be accessed thoracoscopically.
Three to four, one inch incisions are made in the flank with the patient lying on his or her side. The endoscope is passed into the chest cavity; the endoscope provides the light source and has a 3-chip camera at its tip. The image is transferred to a video monitor. The surgeon works with the images on the video monitor. By removing a small segment of the vertebra straddling the herniated disc, the surgeon can remove the fragment of disc abutting on the spinal cord without manipulation of the spinal cord.
Continuous monitoring of spinal cord function by the Neurophysiology team provides the feedback safety. No fusion is performed in routine disc removal.
Paravertebral and Dumbbell Tumors of the Thoracic Spine Paravertebral and dumbbell tumors in the thoracic spine from T2 through T12 and in hard to reach locations can be removed successfully (Paper). Paravertebral tumors or posterior mediastinal tumors are mostly benign tumors (Schwannomas, Neurofibromas); these tumors can arise from the intercostal nerve and extend into the spinal canal causing spinal cord compression or be purely intrathoracic. When intraspinal extension is significant a hemilaminectomy has been performed for removal of this component during the same operation. Gross total removal of the tumors has been achieved in all cases.
Sympathectomy for hyperhidrosis (see section on hyperhidrosis)
Minimally Invasive techniques using endoscopy for treatment of pathologies in the thoracic spine requiring anterior surgery, has significantly reduced the number of thoracotomies at our institution. Thoracoscpic surgery is most appropriate for large calcified thoracic discs causing spinal cord compression.
Thoracoscpy reduces the significant pain associated with an open chest operation (Thoracotomy). Allows early mobilization of patients and discharge from the hospital as well as allowing earlier return to normal activities.
Thoracoscopic techniques reduce the shoulder girdle dysfunction caused by taking down these muscles, thus promoting faster recovery following surgery. All thoracoscopic procedures are performed with the thoracic surgeon (Dr. Cliff Connery)
Paravertebral tumors and dumbbell Neurofibromas / Schwannomas
Thoracoscopic techniques are used predominantly for the removal of these tumors with or without a small opening into the spinal canal as appropriate to remove the Intra-spinal component of the tumor (Fig)
Traumatic and Metastatic fractures In the thoracic spine requiring anterior surgery for reduction and stabilization
Thoracoscopic Sympathectomy for Hyperhidrosis (see section on hyperhidrosis)