H D Jho1. 1. Center for Minimally Invasive Neurosurgery, Department of Neurological Surgery, Presbyterian University Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. hdjho@neuronet.pitt.edu
Abstract
OBJECT: To reduce the invasiveness and risk of thoracic disc surgery, a transpedicular endoscopic approach has been created. The surgical technique and outcome of endoscopic transpedicular thoracic discectomy are reported. METHODS: The surgical technique of posterior transpedicular thoracic discectomy was modified to endoscopic transpedicular surgery. A 1.5-cm trocar was placed in the interlaminar space via a 2-cm transverse paramedian skin incision. At the ventral aspect of the spinal cord discectomy was performed under direct visualization by using a 70 degrees -lens endoscope. This surgical technique was used in 25 patients. Twelve patients were men and 13 were women, aged 29 to 70 years (median 46 years). Myelopathy, with or without radiculopathy was present in 13 patients, radiculopathy in 10, and segmental pain in two. The follow-up periods ranged from 4 to 60 months (median 27 months). In 12 of the 13 patients with myelopathy excellent improvement was shown postoperatively; the remaining patient suffered recurrence of symptoms after a motor vehicle accident three months postoperatively. In nine of the 10 patients with radiculopathy, pain was resolved completely. In one patient with right-sided hypochondral pain and two patients with segmental pain, relief was not achieved despite excellent results of discectomy demonstrated on postoperative magnetic resonance imaging. The average length of hospital stay was one night. CONCLUSIONS: Endoscopic transpedicular thoracic discectomy was found to be a minimally invasive and effective surgical treatment.
OBJECT: To reduce the invasiveness and risk of thoracic disc surgery, a transpedicular endoscopic approach has been created. The surgical technique and outcome of endoscopic transpedicular thoracic discectomy are reported. METHODS: The surgical technique of posterior transpedicular thoracic discectomy was modified to endoscopic transpedicular surgery. A 1.5-cm trocar was placed in the interlaminar space via a 2-cm transverse paramedian skin incision. At the ventral aspect of the spinal cord discectomy was performed under direct visualization by using a 70 degrees -lens endoscope. This surgical technique was used in 25 patients. Twelve patients were men and 13 were women, aged 29 to 70 years (median 46 years). Myelopathy, with or without radiculopathy was present in 13 patients, radiculopathy in 10, and segmental pain in two. The follow-up periods ranged from 4 to 60 months (median 27 months). In 12 of the 13 patients with myelopathy excellent improvement was shown postoperatively; the remaining patient suffered recurrence of symptoms after a motor vehicle accident three months postoperatively. In nine of the 10 patients with radiculopathy, pain was resolved completely. In one patient with right-sided hypochondral pain and two patients with segmental pain, relief was not achieved despite excellent results of discectomy demonstrated on postoperative magnetic resonance imaging. The average length of hospital stay was one night. CONCLUSIONS: Endoscopic transpedicular thoracic discectomy was found to be a minimally invasive and effective surgical treatment.