ABSTRACT
A variety of surgical techniques have traditionally been used to deal with thoracic spinal disorders and deformity They include laminectomy, pediculectomy, costotransversectomy, lateral extracavitary, transverse arthropediculectomy, transthoracic-transpleural thoracotomy, and thoracoscopy (12,19,21,28,29,35,49,55,56). Fessler and Sturgill, based on a review of the literature over the last 60 years, compared relative rates of morbidity and mortality in surgical approaches for thoracic discectomy. They noted that mortality dropped to nearly zero after development of anterior and posterolateral approaches and suggested that laminectomy does not provide adequate access for the safe removal of these lesions (21). Bohlman and Zdeblick reported excellent results in 16 of 19 patients undergoing an anterior approach for thoracic disk removal. They recommended the transthoracic over the costotransversectomy approach for anterior decompression of a herniated thoracic disk, as it greatly improved visualization of the anatomical structures (5). However, this technique involves the use of a thoracotomy with rib resection and wide bony resection of vertebral structures to reach the anterior spinal canal. These procedures, whether extrapleural or intrapleural, result in significant perioperative morbidity secondary to pain, difficult ventilation, shoulder girdle dysfunction, and wound-healing problems (20,41,58,59).
