Minimally Invasive Lateral Approach to the Thoracic Spine – Case Report and Literature Overview

Background context: Alternatives to access the anterior portion of the thoracic spine include thoracotomy, thoracoscopy, and transpedicular approaches. These techniques have proven to be either extremely traumatic or to be technically difficult. Consequently, these approaches are not routinely used. The development of new monitoring systems, instruments, and implants allow conventional anterior thoracic surgery to be accomplished through a minimally disruptive way. The extreme lateral interbody fusion (XLIF) is one of these techniques. Purpose: To describe a new surgical approach to the anterior thoracic spine. Study Desing/Setting: Literature overview and case report utilizing the lateral approach to access the anterior thoracic spine. Methods: The lateral access surgery was first developed to approach the lumbar spine. Here we present our experience using this technique to access the thoracic spine in a minimally invasive fashion. Results: This minimally disruptive spine procedure allowed an adequate approach to the thoracic discs, with less soft tissue aggression and intra-operative bleeding, shorter operation time and hospital stay, lower postoperative pain and earlier return to work. Therefore, the potential complications with an anterior open approach were avoided, and the procedures were performed through a single, 5-6 cm incision. Conclusion: The modification of the XLIF technique for thoracic spine is a safe and effective procedure to achieve fusion and indirect decompress the neural structures. This minimal invasive procedure allows through a single small incision the treatment of different conditions of the thoracic spine without the need of posterior supplementation and huge incisions, avoiding open approach complications and maximizing results due to less tissue trauma and adequate exposure of the thoracic discs.