© Georg Thieme Verlag KG Stuttgart · New York
Percutaneous Endoscopic Thoracic Discectomy; Transforaminal Approach
07. April 2010 (online)
Introduction: Because of the increasing use of magnetic resonance imaging (MRI), thoracic soft disc herniations are being easily detected in the early stages. To avoid a high morbidity rate and other complications that are associated with the conventional approach, the authors have applied a percutaneous endoscopic technique.
Methods: From May 2001 to July 2007, fourteen patients with soft lateral or central thoracic disc herniation (TDH) underwent percutaneous endoscopic thoracic discectomy. Under local anesthesia with intravenous sedation, the authors removed the herniated disc through the thoracic intervertebral foramen after performing a foraminoplasty, which is the enlargement of the foramen by cutting the lateral and inferior part of the superior facet with a round cutter. The clinical outcome was evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI).
Results Six patients were male and eight were female, aged 21–75 years (mean: 48.1 years). Mean follow-up period was 60.2 months (15–89 months), mean operative time was 61 min. The mean VAS improved from 6.5 to 3.0 for back pain and 5.8 to 2.5 for leg pain at the final follow-up. The mean ODI scores also improved from 58.1 before surgery to 24.5 at the final follow-up. Conversion to an open procedure was not required for any of the patients.
Discussion: As it has been proven to lessen the morbidity rate, this percutaneous endoscopic thoracic discectomy (PETD) technique for symptomatic soft TDH is a safe and effective method that provides a direct route to the lesion under local anesthesia.
thoracic spine - endoscopy - foraminotomy - discectomy
- 1 Baker JK, Reardon PR, Reardon MJ. et al . Vascular injury in anterior lumbar spine surgery. Spine. 1993; 18 2227-2230
- 2 Lowery GL, Harms J. Principles of load sharing.. In: Bridwell KH, DeWald RL The Textbook of Spinal Surgery, 2nd edn.. Washington: Lippincott-Raven; 1997. pp 155-165
- 3 Benjamin V. Diagnosis and management of thoracic disc disease. Clin Neurosurg. 1983; 30 577-605
- 4 Ahn Y, Lee SH, Park WM. et al . Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note. Neurosurgery. 2003; 99 (S 03) 320-323
- 5 Kim DY, Lee SH, Lee HY. et al . Validation of the Korean version of Oswestry disability index. Spine. 2005; 30 E123-E127
- 6 Arce CA, Dohrmann GJ. Improved diagnosis with computed tomographic scanning and a review of the literature. Surg Neurol. 1985; 23 356-361
- 7 Charles BS, Thomas CC, William TC. et al . Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurgery.. 1998; 88 623-633
- 8 Fessler RG, Sturgill M. Review of complications of surgery for thoracic disc disease. Surg Neurol. 1998; 49 609-618
- 9 Rosenthal D, Rosenthal R, de Simone A. Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine. 1994; 19 1087-1091
- 10 Jho HD. Endoscopic microscopic transpedicular thoracic discectomy, Technical note. Neurosurg Focus. 1998; 4 ((2)) e7
- 11 Perez Cruet MJ, Kim BS, Sandhu F. et al . Thoracic microendoscopic discectomy. J Neurosurg Spine. 2004; 1 58-63
- 12 Chiu JC, Clifford TJ, Sison R. Percutaneous microdecompressive endoscopic thoracic discectomy for herniated thoracic discectomy. Surg Technol Int.. 2002; 10 266-269
H. Y. LeeMD, PhD
Department of Neurosurgery
Wooridul Spine Hospital
Republic of Korea
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