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

Abstract

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. 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. Neurological symptoms were improved postoperatively, and there were no surgical complications. There was no instability or recurrence during the follow-up period. The oblique paraspinal approach may offer an alternative surgical option for treating TDHs.