In his latest installment to the Total Spine series of instructional videos, Dr. Paul McCormick describes retropleural thoracotomy, a surgical technique used to treat complex spinal conditions of the thoracic and lumbar spine. “Retropleural thoracotomy is an important procedure in spine surgery,” Dr. McCormick notes, “and it has many benefits.” The six-minute video outlines these advantages while offering a step-by-step surgical guide and relevant case studies.
Sponsored by New York Presbyterian (NYP) and Och Spine Hospital, the Total Spine series seeks to educate and enhance the expertise of doctors treating patients with spinal conditions, through insights from leading surgeons at the Och Spine/NYP hospital. The videos also provide patients and other lay readers with clear, detailed descriptions of spine surgery procedures.
In the retropleural thoracotomy video, Dr. McCormick describes a technique that he has long advanced for the treatment of ventral thoracic and thoracolumbar spine abnormalities, detailing several kinds of tumors that can be removed with the procedure. The video incorporates visual aids including text bullet points, detailed diagrams, and images from surgical operations to illustrate certain steps. “Here you see the tumor in the middle, nicely exposed, good access to it,” Dr. McCormick says of one case study. “We can easily and safely remove this tumor and not have to worry about putting a chest tube in.”
Indeed, the fact that retropleural thoracotomy is an extrapleural dissection—allowing the surgeon to avoid inserting a chest tube—is one of several benefits Dr. McCormick cites for the procedure. Others include:
- It provides ventral access to the spinal column via the shortest distance to the ventral spinal canal
- It is often not a destabilizing procedure
- There is no nerve sacrifice
- It can be modified to meet surgical objectives—including minimally invasive surgery (MIS), intradural, paraspinal, or thoracolumbar exposures
The video includes several case studies involving MIS. One shows a patient lying sideways on a bean bag chair, while Dr. McCormick describes a “hockey-stick shaped incision” of less than six centimeters in the upper thoracic area. “The key here is that you can modify this incision,” Dr. McCormick explains. “You can make it smaller for minimally invasive exposure, or you can make it larger or even shift it anteriorly, depending on the pathology.”
Other case studies range from the treatment of an intradural calcified disc herniation—a complex operation requiring a stabilization procedure afterward—to removal of an intradural intramedullary tumor, using a small incision and MIS. The video concludes with a postoperative image of the latter, showing the small amount of bone that was removed to excise the tumor. Recounting the minimally invasive procedure, Dr. McCormick sums up the value of retropleural thoracotomy: “getting us safely and effectively to the ventral spinal canal.”
For more about Dr. McCormick and his expertise, please visit his bio page.