The most common pathologies in the thoracic spine requiring corpectomy are tumors, trauma, and infection [2�C4]. Treating these pathologies can require significant anterior reconstruction, made challenging due to the ribs and other selleck chemical adjacent critical structures including the lungs, pleura, aorta, and mediastinum [5]. Obtaining adequate exposure for corpectomy is critical due to the relative intolerance of the thoracic spinal cord to manipulation and mobilization [1, 3, 6]. Additionally, the numerous comorbidities usually present in these patients often preclude the systemic stress of open surgery [7]. Minimally invasive techniques in the cervical and lumbar spine have been clearly demonstrated to lower surgical blood loss, pain, improve wound healing, and shorten hospital stay [8�C10].

In the thoracic spine, their advent is allowing surgeons to consider treatment for patients who previously would have been relegated to bracing and palliative pain relief due to risks of open surgery. Reports have emerged describing minimally invasive variants to nearly every open thoracic approach to corpectomy [3, 11�C15]. We present here the treatment options described in the literature, with an emphasis on specific advantages, disadvantages, and surgical nuance (Table 1). Table 1 Advantages and limitations of various minimally invasive approaches. 2. Transthoracic Thoracotomy to access the anterior thoracic spine was first described in the 1950s [16].

Used initially primarily in the treatment of thoracic disc herniation, it found significant popularity in the 1970s and 1980s in response to the disappointing results for laminectomy for decompression and discectomy, due to poor outcomes associated with manipulation of the thoracic spinal cord [1, 6, 17�C19]. Surgery involves placing patients in the lateral position, making a lengthy incision laterally along the associated rib, performing thoracotomy, and retracting the lung anteriorly. The parietal pleura is then split close to the rib head, allowing visualization of the costovertebral joint. The costovertebral ligaments and rib head are removed creating anterolateral visualization of the vertebral body, allowing discectomy and corpectomy. Closure includes leaving a chest tube, typically for three days of recumbent drainage [1, 17, 18]. While early reports showed good associated outcomes, surgical morbidity quickly prompted surgeons to explore other approaches [2, 5].

Approach related complications include pulmonary contusion, atelectasis, pleural effusion, chylothorax, and hemothorax Entinostat [5, 7]. Video-assisted thoracoscopy has allowed surgeons to avoid much of the incision- and dissection-related morbidity associated with thoracotomy [11, 20, 21]. Similar to thoracotomy, the patient is intubated with a double endotracheal tube with deflation of the ipsilateral lung, in a lateral position.