Rusconi Angelo, Roccucci Paolo, Peron Stefano, Stefini Roberto
Department of Neurosurgery, Azienda Socio-Sanitaria Territoriale Ovest Milanese, Legnano Civil Hospital, Milan, Italy.
J Neurosurg Case Lessons. 2021 Jun 28;1(26):CASE21262. doi: 10.3171/CASE21262.
Thoracic disc herniation (TDH) represents a challenge for spine surgeons. The goal of this study is to report the surgical technique and clinical results concerning the application of navigation to anterior transthoracic approaches.
Between 2017 and 2019, 8 patients with TDH were operated in the lateral decubitus by means of mini-open thoracotomy. An adapted patient referent frame was secured to the iliac wing. The high-speed drill was also navigated. Intraoperative three-dimensional scans were used for level identification, optimized drilling trajectory, and assessment of complete resection. At 12 months follow up, all patients were ambulatory. Seven out of 8 patients (87%) experienced a postoperative neurological improvement. We observed 2 postoperative complications: 1 case of pleural effusion and 1 case of abdominal wall weakness.
In order to increase the safety of anterior transthoracic discectomy, the authors applied the concepts of spinal navigation to the thoracotomy setting. The advantages of this technique include decrease in wrong-level procedure, continuous matching of intraoperative and navigation anatomical findings, better exposure of the TDH, optimized vertebral body drilling, and minimized risk of neurological damage. In conclusion, the authors consider spinal navigation as an important resource for the surgical treatment of patients with TDH.
胸椎间盘突出症（TDH）对脊柱外科医生来说是一项挑战。本研究的目的是报告关于在经胸前路手术中应用导航技术的手术技巧和临床结果。
2017年至2019年期间，8例TDH患者通过侧卧位经小切口开胸手术进行治疗。将适配的患者参考框架固定于髂翼。高速磨钻也采用导航技术。术中使用三维扫描进行节段定位、优化磨钻轨迹并评估切除是否彻底。在12个月的随访中，所有患者均能行走。8例患者中有7例（87%）术后神经功能得到改善。我们观察到2例术后并发症：1例胸腔积液和1例腹壁无力。
为提高经胸前路椎间盘切除术的安全性，作者将脊柱导航概念应用于开胸手术中。该技术的优点包括减少手术节段错误、术中解剖结构与导航结果持续匹配、更好地暴露TDH、优化椎体磨钻以及将神经损伤风险降至最低。总之，作者认为脊柱导航是TDH患者手术治疗的重要手段。
