J Korean Soc Spine Surg.  2006 Sep;13(3):200-204. 10.4184/jkss.2006.13.3.200.

Treatment of Upper Thoracic Disc Herniation Using Transthoracic Approach without Division of Latissimus Dorsi: Technical Note

• Shim DM
• Kim JW
• Park JY
• Yang HD
• Park SK
• Kweon SH
• Jeung UO
• Kim BG

• KMID: 2209642
• DOI: http://doi.org/10.4184/jkss.2006.13.3.200

Abstract

Thoracic disc herniation is a rare condition in which a posterior approach, extrapleural approach, posterolateral approach, or transthoracic approach is currently used. The posterior approach is not recommended in thoracic disc herniation surgery because of the risk of spinal cord injury. The transthoracic approach makes it possible to remove the intervertebral disc and is considered a standard method. However, due to an extensive transverse skin incision, division of the latissimus dorsi muscles, and rib resection, the conventional open approaches involve a risk of complications, such as infection and post-thoracotomy pain syndrome; and a long period of rehabilitation and recovery is required. Excision of the intervertebral disc under thoracoscopic guidance can reduce the damage to the skin and muscles, but the equipment and surgical materials are expensive and a long learning curve is required. Therefore, we report a case and a new muscle splitting transthoracic approach that can be performed by incising 10 cm of skin longitudinally and preserving the serratus anterior and latissimus dorsi muscles.

Keyword

Upper thoracic disc herniation; Transthoracic approach; Non-division of latissimus dorsi

MeSH Terms

Intervertebral Disc
Learning Curve
Muscles
Rehabilitation
Ribs
Skin
Spinal Cord Injuries
Superficial Back Muscles*

Figure

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  Fig. 1. (A) Sagittal T2 weighted magnetic resonance image shows a disc extrusion at T3/4. (B) Axial T2 weighted magnetic resonance image shows a right posterolateral disc herniation.

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  Fig. 2. White line indicates incision to be made in skin along the anterior border of latissimus dorsi muscle.

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  Fig. 3. (A) 10 cm straight longitudinal incision is made to skin along the anterior border of latissimus dorsi muscle. (B) Instead of dividing muscle, dissection is carried out between serratus anterior muscle and latissimus dorsi muscle to preserve them. (C) Latissimus dorsi muscle is retracted posteriorly by self retractor. (D) A rib spreader is inserted to hold the ribs apart.

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