Mini-thoracotomy or thoracoscopic treatment for medially located thoracic herniated disc?

STUDY DESIGN: A retrospective cohort study.

OBJECTIVE: Comparison of the mini-thoracotomy (mini-TTA) and thoracoscopy for the treatment of calcified thoracic herniated disc.

SUMMARY OF BACKGROUND DATA: Thoracoscopy has been popularized at the cost of the traditional thoracotomy for the treatment of calcified herniated discs. However, the learning curve is steep. Given the low incidence of herniated thoracic discs, it will be difficult for a group of spinal surgeons to gain experience. Newer, minimally invasive techniques with a nearly absent learning curve are evolving. One of these techniques is the mini-TTA.

METHODS: Retrospectively, the charts of patients that underwent a mini-TTA or thoracoscopy were retrieved.

RESULTS: Seven patients underwent a thoracoscopy, and 21 a mini-TTA. Although the groups are limited, a statistical significant difference in gender, age, duration of surgery, duration of the necessity of a chest drain, intraoperative blood loss, or duration of the postoperative stay on the intensive care unit was not reached. At the last follow-up in the thoracoscopic group, 2 patients had some neuropathic thoracic incisional pain. In all patients, a complete removal of the calcified disc was ascertained with a postoperative computed tomography scan.

CONCLUSION: The mini-TTA has some theoretical advantages over a thoracoscopy. It is also a minimally invasive approach. The thoracoscopy has a steep learning curve, whereas the mini-TTA is simple to apply. Classic microsurgical bimanual techniques can be used.