Minimally invasive lateral approach to the thoracic spine and thoracolumbar junction

Traditional thoracotomy has long been established as an effective technique for treating anterior-based pathologies of the thoracic spine but is associated with significant morbidity, including high rates of respiratory complications and persistent thoracic wall pain. In response to these limitations, the minimally invasive lateral approach to the thoracic spine and thoracolumbar junction has emerged as a less morbid alternative, while offering comparable surgical access to the vertebral body, disc, and anterior spinal canal. This approach enables treatment of a wide range of pathologies — including trauma, infection, neoplasia, degeneration, and deformity — through procedures such as discectomy, spinal cord decompression, interbody fusion, corpectomy, and anterolateral instrumentation. Careful patient selection, thorough preoperative planning, and precise anatomical understanding are essential for its safe and effective application. This paper reviews the indications, contraindications, anatomical considerations, surgical technique, outcomes, and complications associated with the minimally invasive lateral approach, with particular emphasis on anatomical relationships of critical structures — including the diaphragm, aorta, and azygos vein — and technical aspects such as patient positioning, incision planning, diaphragm management, and retractor systems. Published clinical data demonstrating reductions in operative time, blood loss, hospital stay, and approach-related morbidity compared to traditional thoracotomy — while achieving equivalent or superior fusion rates and deformity correction — are outlined, along with evidence supporting the utility of this approach for specific anterior spinal pathologies. This paper provides a comprehensive resource for surgeons incorporating the minimally invasive lateral approach to the thoracic and thoracolumbar spine into their clinical practice.