Introduction: Minimally invasive direct thoracic interbody fusion (MIS-DTIF) is a new single surgeon procedure for fusion of the thoracic vertebrae below the scapula (T6/7) to the thoracolumbar junction. In this proof of concept study, we describe the surgical technique for MIS-DTIF and report our experience and the perioperative outcomes of the first four patients who underwent this procedure.

Methods: In this study, we establish the safety and efficacy of MIS-DTIF performed on six spinal levels in four patients with degenerative disk disease or disk herniation. We recorded surgery time, blood loss, fluoroscopy time, complications, and patient-reported pain. Throughout the MIS-DTIF procedure, the surgeon is aided by biplanar fluoroscopic imaging and electrophysiological monitoring. The surgeon approaches the spine with a series of gentle tissue dilations and inserts a working tube that establishes a direct connection from the outside of the skin to the disk space. Through this working tube, a discectomy is performed with interbody graft or cage placement. The procedure is completed with minimally invasive posterior pedicle screw fixation.

Results: Single-level patients, mean blood loss was 90ml, surgery time 43 minutes, fluoroscopy time 293 seconds, hospital stay two days. Two-level surgeries, mean blood loss was 27ml, surgery time 61 minutes, fluoroscopy time 321 seconds, and hospital stay three days. No clinically significant complications were encountered. Thirty days post-surgery, the patients reported a significant reduction of 5.3 points on a 10-point pain scale.

Conclusions: MIS-DTIF with pedicle screw fixation is a safe and clinically effective procedure for fusions of the thoracic spine. The procedure is technically straightforward and overcomes many of the limitations of the current thoracic spine MIS approaches. MIS-DTIF has the potential to improve patient outcomes and reduce costs relative to the current standard of care. We are currently expanding this study to a larger cohort and recording long-term outcomes and costs.

Patient Care: MIS-DTIF has the potential to improve patient outcomes and reduce costs relative to the current standard of care.

Learning Objectives: Fusion of the thoracic spine with MIS-DTIF approach provides less risk to the patient without collapsing a lung or removal of rib(s) in order to access the thoracic spine.

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