{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T22:25:27Z","timestamp":1759962327579,"version":"3.30.1"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>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. This study 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This study was a single-institution retrospective evaluation of consecutive cases from 2017 to 2022. Electronic medical records were reviewed, including postoperative chest radiographs, radiology and operative reports, and postoperative notes. The presence of PTX or HTX was determined on chest radiographs obtained in all patients immediately after surgery, with interval radiographs if either was present. The size was categorized as large (\u2265 3 cm) or small (&lt; 3 cm) based on guidelines of the American College of Chest Physicians. PTX or HTX was considered clinically significant if it required intervention.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Thirty patients underwent thoracic discectomy via the MO-LRP approach. All patients were included. Twenty patients were men (67%), and 10 (33%) were women. The patients ranged in age from 25 to 74 years. The most commonly treated level was T11\u201312 (n = 11, 37%). Intraoperative violation of parietal pleura occurred in 5 patients (17%). No patient had prophylactic chest tube placement. Fifteen patients (50%) had PTX on postoperative chest radiographs; 2 patients had large PTXs, and 13 had small PTXs. Both patients with large PTXs had expansion on repeat 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 (10%) required a chest tube: 2 for expanding PTX and 1 for delayed HTX.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Most patients who undergo thoracic discectomy via the MO-LRP approach do not develop clinically significant PTX or HTX. PTX and HTX in this patient population should be treated with a chest tube only when there are postoperative clinical and radiographic indications.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.12.spine23128","type":"journal-article","created":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T01:56:48Z","timestamp":1719021408000},"page":"445-451","source":"Crossref","is-referenced-by-count":1,"title":["Incidence of radiographic and clinically significant pneumothorax or hemothorax after thoracic discectomy via mini-open lateral retropleural approach without prophylactic chest tube placement"],"prefix":"10.3171","volume":"41","author":[{"given":"Nima","family":"Alan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. Harrison","family":"Farber","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James J.","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve S.","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke K.","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert K.","family":"Dugan","sequence":"additional","affiliation":[{"name":"Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate L.","family":"Petty","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Pablo","family":"Leal Isaza","sequence":"additional","affiliation":[{"name":"Instituto de Neurociencias, Santa F\u00e9 Foundation, Universidad El Bosque, Bogot\u00e1, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay D.","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura A.","family":"Snyder","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan S.","family":"Uribe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Neurosurg","first-page":"334","article-title":"Complications associated with surgery for thoracic disc herniation: a systematic review and network meta-analysis","volume":"132","author":"Brotis AG","year":"2019","unstructured":"Brotis AG, Tasiou A, Paterakis K, Tzerefos C, Fountas KN. Complications associated with surgery for thoracic disc herniation: a systematic review and network meta-analysis. World Neurosurg. 2019;132:334\u2013342."},{"issue":"1S","key":"b2","series-title":"Orthop Traumatol Surg Res","first-page":"S31","article-title":"Thoracic disc herniation: surgical treatment","volume":"104","author":"Court C","year":"2018","unstructured":"Court C, Mansour E, Bouthors C. Thoracic disc herniation: surgical treatment. Orthop Traumatol Surg Res. 2018;104(1S):S31\u2013S40."},{"issue":"7","key":"b3","series-title":"Clin Spine Surg","first-page":"E901","article-title":"Surgical approaches for the treatment of thoracic disk herniation: results of a decision analysis","volume":"30","author":"Nayak NR","year":"2017","unstructured":"Nayak NR, Bauman JA, Stein SC, Thawani JP, Malhotra NR. Surgical approaches for the treatment of thoracic disk herniation: results of a decision analysis. 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