H D Jho1. 1. Center for Minimally Invasive Innovative Microneurosurgery, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA. hdjho@neuronet.pitt.edu
Abstract
OBJECT: To minimize the invasiveness and maximize the adequacy of the decompressive procedure in thoracic discectomy, a 70 degrees endoscope was adapted to perform transpedicular thoracic discectomy. METHODS: A posterior transpedicular approach was performed via a 2-cm transverse skin incision, aided by an operating microscope or a 0 degrees lens endoscope. Using a 70 degrees 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 ages ranged from 29 to 74 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 13 patients with myelopathy, excellent improvement was shown postoperatively. In the remaining patient, symptoms recurred after 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 demonstrated on postoperative magnetic resonance images. The average length of hospital stay was overnight. CONCLUSIONS: The use of a 70 degrees lens endoscope through a transpedicular route has made thoracic discectomy comparable with cervical or lumbar discectomy in terms of minimal surgical invasiveness, recovery time, and complexity of the procedure.
OBJECT: To minimize the invasiveness and maximize the adequacy of the decompressive procedure in thoracic discectomy, a 70 degrees endoscope was adapted to perform transpedicular thoracic discectomy. METHODS: A posterior transpedicular approach was performed via a 2-cm transverse skin incision, aided by an operating microscope or a 0 degrees lens endoscope. Using a 70 degrees 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 ages ranged from 29 to 74 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 13 patients with myelopathy, excellent improvement was shown postoperatively. In the remaining patient, symptoms recurred after 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 demonstrated on postoperative magnetic resonance images. The average length of hospital stay was overnight. CONCLUSIONS: The use of a 70 degrees lens endoscope through a transpedicular route has made thoracic discectomy comparable with cervical or lumbar discectomy in terms of minimal surgical invasiveness, recovery time, and complexity of the procedure.