Transforaminal Endoscopic Thoracic Discectomy
Presented at SMISS Annual Forum 2018
By Junseok Bae
With Wensheng Zhang ,
Disclosures: Junseok Bae B; Joimax GmbH. Wensheng Zhang None,
Symptomatic soft herniated thoracic disc (HTD) before use of magnetic resonance imaging (MRI) was a rare disease with less than 1% of all spinal disc herniation. The frequency of diagnosis of thoracic disk herniation has increased with the use of magnetic resonance imaging (MRI) routinely. To avoid high morbidity and complications associated with conventional approach, the authors applied posterolateral endoscopic technique.
To present outcomes after PLETD for HTD.
From January 2001 to December 2016, 87 patients with non-sequestrated and soft lateral or central thoracic disc herniation underwent posterolateral endoscopic thoracic discectomy (PLETD). Under local anesthesia with intravenous sedation, the authors removed the herniated disc through thoracic intervertebral foramen after foraminoplasty: the enlargement of the foramen by partially cutting the lateral aspect of superior facet with a Reamer or high speed diamond drills. Clinical outcome was measured by the Oswestry Disability Index (ODI) and the visual analog scale.
Fifty-one patients were male and thirty-six were female, aged 21 to 89 years (mean 50.8 years). Mean follow up period was 10 months (1 to 56 months). The mean ODI scores improved from 53.7 before surgery to 16.9 at the final follow-up. (P < 0.05). mean VAS scores improved from 7.3 before surgery to 2.1 at the final follow-up. (P < 0.05). As a complication 1 patient required conversion to an open procedure for recurred disc protrusion in 17 days. And 1 patient required repeated PLETD for recurred disc in l year. Three patients experienced transient low extremity paresthesia but all improved. There were no other serious complications associated with this procedure.
Conventional treatment of HTD is known to have a high morbidity and complication and a challenge to physicians. This PLETD technique for symptomatic non-sequestrated and soft HTD is a safe and effective method that provides direct route to the lesion under local anesthesia with less morbidity.