Endoscopic transpedicular thoracic discectomy

Abstract

Object To minimize the invasiveness and maximize the adequacy of the decompressive proceedure in thoracic discectomy, a 70° endoscope was adopted to perform transpedicular thoracic discectomy. Methods A posterior transpedicular approach was performed via a 2-cm transverse skin incision, using the operating microscope or a 0°-lens endoscope. Using a 70°-lens endoscope, discectomy was performed after obtaining direct visualization of the ventral aspect of the spinal cord dura mater. This surgical technique has been used in 25 patients. There were 12 men and 13 women whose age ranged from 29 to 70 years (median 46 years). Thirteen patients experienced myelopathy, with or without radiculopathy, 10 presented with radiculopathy, and two patients suffered from segmental pain. The follow-up period ranged from 4 to 60 months (median 27 months). In 12 of the 13 patients with myelopathy, excellent improvement was shown postoperatively. In the remaining patient, symptoms recurred when she was injured in a motor vehicle accident 3 months postsurgery. In nine of 10 patients with radiculopathy pain resolved completely. In the one patient with right-sided hypochondral pain and in the two patients with segmental pain no relief was obtained despite excellent discectomy results that were demonstrated on postoperative magnetic resonance images. The average length of hospital stay was overnight. Conclusions The use of a 70°-lens endoscope via a transpedicular route has made thoracic discectomy comparable with cervical or lumbar discectomy in its surgical invasiveness, in the patient's recovery time, and in complexity of surgical procedure.