The role of intraoperative ultrasound during lateral extracavitary approach in thoracic disc herniation surgery. Tips and tricks for lateral approaches.

Thoracic disc herniation (TDH) is one of the most complex and technically challenging pathologies in spine surgery. Multiple approaches have been described to manage this condition, including the lateral extracavitary approach (LECA). The use of intraoperative ultrasound (IOUS) has been scarcely described in TDH surgery and the available experiences have been limited to posterolateral approaches. To our knowledge, the implementation of IOUS in LECA-based surgery has not yet been described in the literature. In this article, we describe how we use IOUS in these cases, including our step-by-step technique and its potential benefits. We performed LECA-based surgery to treat a T10-T11 predominantly central calcified TDH in a 55-year-old patient with severe neurological deficit of lower limbs. On the one hand, LECA provided us an excellent view of the anterior midline aspect of the spinal canal. On the other hand, we used IOUS to ensure the location and degree of resection of the TDH. There were no major technical difficulties during its use. We achieved gross total resection of the TDH and the patient progressively regained mobility in the lower limbs.