Controversies in Spine Surgery, MIS Versus OPEN by Alexander R. Vaccaro Richard G. Fessler Fareem A. Sandhu

Author:Alexander R. Vaccaro,Richard G. Fessler,Fareem A. Sandhu
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2018-01-18T16:00:00+00:00

11.13 Conclusion of Open Surgery

Today, the vast majority of procedures for thoracic spine pathology are performed through anterior and posterolateral exposures. Small central TDH are adequately treated via an MIS anterior approach. A posterolateral approach is well suited to address a lateral TDH. For broad, medial, calcified, and multilevel herniations, an anterior open transthoracic approach is the best option, given that it is easily expansile.

The relevant literature on the topic of approaches for the treatment of TDH is considered level III or IV evidence and involves various procedures used to treat heterogeneous pathology. The methods are subject to bias and the compiled results are difficult to interpret. Therefore, there is no high-level comparative evidence that establishes a benefit to MIS approaches for TDHs compared to open approaches. Although these data may become available in the future, there is currently no compelling evidence to justify the technical difficulty, cost, and potential for catastrophic vascular complications associated with a minimally invasive approach. If patient-based outcomes are comparable, practice considerations and surgeon preferences determine whether assimilating the techniques would be advantageous for this low-incidence pathology. Because these approaches are all very different operations with characteristic indications and complication profiles, each approach should be compared separately. A grade IIB recommendation is made for open thoracic discectomy to effectively treat symptomatic TDHs. More prospective, randomized, matched cohort and other higher quality studies are recommended to explore these surgical options.

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