(I-609) Incidence of radiographic and clinically significant pneumothorax or hemothorax after thoracic diskectomy via mini-open lateral retropleural approach without prophylactic chest tube placement
Fellow Barrow Neurological Institute, United States
Introduction: The mini-open lateral retropleural (MO-LRP) approach is an effective option for surgically treating thoracic disc herniations, but the approach raises concerns for pneumothorax (PTX). However, chest tube placement causes insertion site tenderness, necessitates consultation services, increases radiation exposure (requires multiple radiographs), delays the progression of care, and increases narcotic requirements. Thus, we examined the incidence of radiographic and clinically significant PTX and hemothorax (HTX) after the MO-LRP approach—without the placement of a prophylactic chest tube—for thoracic disc herniation.
Methods: This study is a single-institution, retrospective evaluation of consecutive cases from 2017-2022. Postoperative chest radiographs, radiology and operative reports, and postoperative notes were reviewed. The presence of PTX or HTX was determined on chest radiographs obtained for all patients immediately after surgery, with interval radiographs if either were present. The size was categorized as large (≥3 cm) or small ( < 3 cm) based on American College of Chest Physician guidelines. PTX or HTX was considered clinically significant if it required intervention.
Results: Thirty patients underwent thoracic diskectomy via the MO-LRP approach. Twenty patients were men (67%), and 10 (33%) were women. Patient age ranged from 25-74 years. The most commonly treated level was T11-12 (n=11, 37%). Intraoperative violation of parietal pleura occurred in 5 patients (17%). No patient had prophylactic chest tube placement. Fifteen patients had PTX on postoperative chest radiographs (50%); 2 patients had large, and 13 had small PTXs. Both patients with large PTXs had expansion on repeated radiographs and were treated with chest tube insertion. Of the 13 patients with a small PTX, 1 required 100% oxygen using a nonrebreather mask; the remainder were asymptomatic. One patient, who had no abnormal findings on the immediate postoperative chest radiograph, developed an incidental HTX on postoperative day 6 and was treated with chest tube insertion. Thus, 3 patients required a chest tube (10%): 2 for expanding PTX and 1 for delayed HTX.
Conclusion : Most patients who undergo thoracic diskectomy via the MO-LRP approach do not develop clinically significant PTX or HTX. PTX in this patient population should only be treated with a chest tube when indicated.
