Thoracic Endoscopic Spine Surgery: A Comprehensive Review

Abstract

Background: From the 1990s, there has been growth in the literature demonstrating the feasibility of minimally invasive approaches for treating diverse spinal disorders. There is still much work to be done in circumnavigating the technical challenges and elucidating relative advantages of endoscopic techniques in spine surgery. In this comprehensive literature review, we discuss the history, advantages, disadvantages, approaches, and technology of, and critically examine peer-reviewed studies specifically addressing, endoscopic thoracic spinal surgery. Methods: Literature review was conducted with the key words ''endoscopic,'' ''minimally invasive,'' and ''thoracic spinal surgery,'' using PubMed, Web of Science, and Google Scholar. Results: Review of 241 thorascopic procedures showed a success rate of 98% to 100%, low morbidity, and favorable complication profile. Review of 115 thoracic fixation procedures demonstrated high success rate, and 87% of screw positions were rated ''good.'' Review of 55 full endoscopic uniportal decompressions showed sufficient decompression in most patients. Match pair analysis of 34 patients comparing video-assisted thoracoscopy surgery (VATS) or posterior spinal fusion reported the VATS group had increased operative duration but reduced blood loss. Conclusions: Based on our literature review, there is a high rate of positive outcomes with endoscopic thoracic spine surgery, which reduces tissue dissection, intraoperative blood loss, and epidural fibrosis. However, the technical challenge highlights the importance of further training and innovation in this rapidly evolving field. Level of Evidence: 3. Clinical Relevance: There is growing evidence demonstrating the success of endoscopic thoracic spinal surgery. Populations that could be helped include the elderly and immunocompromised, who would benefit from decreased hospital stay and enhanced recovery time.

Spinal endoscopy: evidence, techniques, global trends, and future projections

“…[49] Thoracic Spine Endoscopic techniques have been utilized in the treatment of thoracic spine pathology for decades, though the literature is not as common or robust as that for lumbar and cervical conditions. [18,[50][51][52][53][54][55][56][57][58] Early iterations began in the 1990s, when Rosenthal adapted techniques used in video-assisted thoracoscopy and pioneered what was described as transthoracic thoracoscopy for treatment of thoracic disc herniations. [54] Although this technique was effective in terms of pain reduction and neurologic outcomes; the transthoracic approach, involving selective lung collapse and violation of the pleura, carried with it high postoperative morbidity, including the risk (3.6%) of serious pulmonary complications.…”

Recent Advances in Spine Surgery- Pros and Cons

“…The use of multiple angled endoscopes allows for the viewing of almost 360° of area, which was not achievable with traditional approaches [9]. Endoscopic access using the dorsolateral route removes the need for extensive bone resection and is accomplished directly through the intervertebral foramen window (transforaminal approach), especially in thoracic regions [10]. RSS -Robotic spine systems recognize predefined standard points of reference using a spinous process clamp or pelvic pin and employ an intraoperative navigation system and a robotic arm to implant vertebral pedicle screws.…”

The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation

“…Decompression and fusion are two separate procedures, yet are often combined in this setting to add stability to the affected area [ 33 ]. Decompression is a procedure where a surgeon removes a segment of bone, disc, or ligament over a nerve root to alleviate neural pressure that causes pain [ 34 , 35 ]. A fusion is a procedure that structurally joins two segments of a vertebra to add rigidity to the spine or prevent movements that cause pain [ 34 ].…”