Full endoscopic surgery for thoracic pathology: an assessment of supportive evidence

Abstract

In the last five years, surgeons have applied endoscopic transforaminal surgical techniques mastered in the lumbar spine to the treatment of thoracic pathology. The aim of this systematic review was to collate the available literature to determine the place and efficacy of full endoscopic approaches used in the treatment of thoracic disc prolapse and stenosis. An electronic literature search of PubMed, Embase, the Cochrane database and Google Scholar was performed as suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis statements. Included were any full-text articles referring to full endoscopic thoracic surgical procedures in any language. We identified 17 patient series, one cohort study and 13 case reports with single or of up to three patients. Although the majority included disc pathology, 11 papers related cord compression in a proportion of cases to ossification of the ligamentum flavum or posterior longitudinal ligament. Two studies described the treatment of discitis and one reported the use of endoscopy for tumour resection. Where reported, excellent or good outcomes were achieved for full endoscopic procedures in a mean of 81% of patients (range 46–100%) with a complication rate of 8% (range 0–15%), comparing favourably with rates reported after open discectomy (anterior, posterolateral and thoracoscopic) or by endoscopic tubular assisted approaches. Twenty-one of the 31 author groups reported use of local anaesthesia plus sedation rather than general anaesthesia, providing ‘self-neuromonitoring’ by allowing patients to respond to cord and/or nerve stimuli. Cite this article: EFORT Open Rev 2021;6:50-60. DOI: 10.1302/2058-5241.6.200080

Endoscopic Spine Surgery of the Cervicothoracic Spine: A Review of Current Applications

“…The review included papers from 2006 to 2020 comprising 17 patient series, 1 cohort study, and 13 case reports with 1 to 3 patients. 8 In 460 patients, complications reported were dural tears (2%), transient paresthesia (2%), revision surgery (1.5%), neurologic injury (0.6%), and epidural hematoma (0.6%). [19][20][21][22][23][24][25][26][27][28][29][30][31][32] The review concluded that there was clear evidence for a lower complication rate and shorter hospital stay with endoscopic thoracic spine surgery approaches versus open approaches.…”

“…Moreover, there were no reported cases in the endoscopic experience of wrong-level surgery, vertebral column instability, cerebrospinal fluid leaks/pleural fistulas, thoracic viscera injury, or intercostal neuralgia. 8…”

“…Endoscopic approaches to the cervicothoracic spine have been reported in the literature and found to be safe and effective. 7,8 Here, we review 4 techniques for fully endoscopic cervical spine surgery: (1) posterior cervical unilateral laminectomy and bilateral decompression, (2) posterior cervical foraminotomy, (3) anterior cervical discectomy, and (4) anterior transcorporal discectomy. We also review 2 techniques for fully endoscopic thoracic spine surgery: (1) posterior thoracic unilateral laminectomy and bilateral decompression and (2) transforaminal thoracic endoscopic discectomy and foraminotomy.…”

Full Endoscopic Surgery for Thoracic Pathology: Next Step after Mastering Lumbar and Cervical Endoscopic Spine Surgery?

“… Thoracic endoscopes differ from other spinal endoscopes in the following ways ( Figure 1 ): They are angled at 45°. This allows to work with a steeper access route and much shorter in length as the thoracic spine does not have much soft tissue cover dorsally [ 2 , 3 , 12 ] They are smaller in diameter to accommodate space restriction in the thoracic spine Endoreamers/endodrills are available in various sizes and angles. They are used for undercutting the superior facet or removal of a part of the vertebral body.…”

“…Especially, it is very important to identify the entry level of the magna radicular artery and avoid ligating it to prevent paraplegia caused by spinal cord infarction [ 7 ]. Overall, complications from open surgery are reported to occur in over 25% of patients [ 3 ].…”