Percutaneous Endoscopic Thoracic Discectomy in the Upper and Midthoracic Spine: A Technical Note

Bae, Jang–Ho; Chachan, Sourabh; Shin, Sang-Ha; Lee, Sang-Ho

doi:10.14245/ns.1836260.130

Cited by 38 publications

(46 citation statements)

References 14 publications

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“…2 Also, a mild degree of myelopathy due to soft disk herniation without a favorable response to conservative therapy. 1,4,5,7,8 On the other hand, TETD is contraindicated in patients with hard or calcified disc herniation, thoracic ossification of the posterior longitudinal ligament and severe disk narrowing, as well as, severe cord compression and documentation of acute or progressive degenerative spinal cord disease.…”

Section: Surgical Indications and Contraindicationsmentioning

confidence: 99%

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Transforaminal Endoscopic Thoracic Discectomy: Technical Review to Prevent Complications

Choi

Muñoz-Suárez

2020

Neurospine

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For all the spine surgeons, thoracic disc herniations (TDHs) entrust a real challenge in terms of patient diagnosis, proper selection, surgical technique, and potential adverse events. TDHs are relatively uncommon compared to the lumbar and cervical levels. Literature reports a variable prevalence of TDHs around 6% to 40%, but less than 1% of all disk herniations are symptomatic TDHs, evidencing as a relatively unusual condition. Nowadays, transforaminal endoscopic thoracic discectomy (TETD) has been implemented as an alternative to classic open procedures with results that are as good as and, in some situations, better than those in traditional discectomy. However, the surgeon must be familiar with endoscopic lumbar spine surgery before opting to perform a TETD, considering that the learning curve is much harder. We describe all the steps and safety considerations during TETD based on the anatomic differences compared to lumbar endoscopic procedures. TETD is an effective and safe method that yields more benefits, provides a direct route to the lesion with less morbidity, and is performed in a minimally invasive way. Many severe complications related to the thoracic region could be avoided having the proper knowledge, adequate technique, and safety routes and considerations.

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Section: Surgical Indications and Contraindicationsmentioning

confidence: 99%

“…2), and it is more separated from midline due to inclination degree based on the posterior rib edge. The path between the rib head and the thoracic facet is the safest route for the needle into the thoracic disk 1,4,7,8,13 (Fig. 2).…”

Section: Needle Insertion Techniquesmentioning

confidence: 99%

Transforaminal Endoscopic Thoracic Discectomy: Technical Review to Prevent Complications

Choi

Muñoz-Suárez

2020

Neurospine

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“…1 Even with proficiency in the technique, technical challenges can be seen based on the type of procedure being performed. Bae et al 6 studied the use of percutaneous endoscopic thoracic discectomy and found that this procedure can be technically challenging in the surgical treatment of upper and mid thoracic disc herniations because of the complexity of neural and vascular structures. Orientation-related technical hurdles were demonstrated in the same study because a posterior thoracic endoscopic approach offered the surgeon a higher manual dexterity, anatomic familiarity, direct approach to ventral epidural space, and little approach-related morbidity, as opposed to an anterior approach, which involves dissection around risky anatomic structures, general anesthesia, 1-lung ventilation, and nerve root retraction.…”

Section: Disadvantagesmentioning

confidence: 99%

“…Orientation-related technical hurdles were demonstrated in the same study because a posterior thoracic endoscopic approach offered the surgeon a higher manual dexterity, anatomic familiarity, direct approach to ventral epidural space, and little approach-related morbidity, as opposed to an anterior approach, which involves dissection around risky anatomic structures, general anesthesia, 1-lung ventilation, and nerve root retraction. 6 It can also be noted that with increased technicality comes the need for not only an experienced surgeon but an experienced assistant and surgical team. 7 Patient safety must not be sacrificed when examining the disadvantages of using endoscopic approaches in thoracic spine surgery.…”

Section: Disadvantagesmentioning

confidence: 99%

Thoracic Endoscopic Spine Surgery: A Comprehensive Review

et al. 2020

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Background: From the 1990s, there has been growth in the literature demonstrating the feasibility of minimally invasive approaches for treating diverse spinal disorders. There is still much work to be done in circumnavigating the technical challenges and elucidating relative advantages of endoscopic techniques in spine surgery. In this comprehensive literature review, we discuss the history, advantages, disadvantages, approaches, and technology of, and critically examine peer-reviewed studies specifically addressing, endoscopic thoracic spinal surgery. Methods: Literature review was conducted with the key words ''endoscopic,'' ''minimally invasive,'' and ''thoracic spinal surgery,'' using PubMed, Web of Science, and Google Scholar. Results: Review of 241 thorascopic procedures showed a success rate of 98% to 100%, low morbidity, and favorable complication profile. Review of 115 thoracic fixation procedures demonstrated high success rate, and 87% of screw positions were rated ''good.'' Review of 55 full endoscopic uniportal decompressions showed sufficient decompression in most patients. Match pair analysis of 34 patients comparing video-assisted thoracoscopy surgery (VATS) or posterior spinal fusion reported the VATS group had increased operative duration but reduced blood loss. Conclusions: Based on our literature review, there is a high rate of positive outcomes with endoscopic thoracic spine surgery, which reduces tissue dissection, intraoperative blood loss, and epidural fibrosis. However, the technical challenge highlights the importance of further training and innovation in this rapidly evolving field. Level of Evidence: 3. Clinical Relevance: There is growing evidence demonstrating the success of endoscopic thoracic spinal surgery. Populations that could be helped include the elderly and immunocompromised, who would benefit from decreased hospital stay and enhanced recovery time.

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“…Several authors described various transforaminal approach through docking on Kambin's triangle and foraminoplasty 2,18) . Dura is more expanded in the thoracolumbar junction with a higher dura sac ratio as we move more proximally from lumbosacral region to thoracolumbar junction 15) .…”

Section: Introductionmentioning

confidence: 99%

Safe Extraforaminal Docking and Floating Technique in Transforaminal Endoscopic Discectomy for Thoracolumbar Junction for Calcified Disc Herniation: A Case Report and Technical Review Junction for Calcified Disc Herniation

Kim

Raorane

et al. 2020

J Minim Invasive Spine Surg Tech

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Objective: Thoracolumbar disc herniation is an uncommon disabling spine condition. Methods: There is relatively large dura expansion to lateral recess in the thoracolumbar junction leading to potential hazard in docking and execution of endoscopic transforaminal discectomy. Mobile outside in technique had been executed successfully in lumbar disc herniation, we modified the technique to allow safe docking and execution of discectomy in thoracolumbar junction. Herein, we report a case of thoracic twelve lumbar one disc paracentral disc herniation treated with floating transforaminal endoscopic discectomy under local anesthesia. Results: A 46-year-old man with a 3-months of severe back and radicular pain on the right groin. A diagnosis of right T12/L1 paracentral disc herniation was made, based on clinical and radiological investigations. He underwent percutaneous transforaminal endoscopic thoracolumbar discectomy with floating technique. Over a follow-up of 6 months, a favorable outcome was noted. Conclusion: Floating technique of transforaminal endoscopic thoracolumbar junction discectomy is a safe and an effective surgical approach for the treatment of thoracolumbar disc herniation. In patients with thoracolumbar disc herniation, careful patient selection and evaluation neural elements anatomy in relation to bony anatomy is important in preparation for endoscopic decompression.

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Percutaneous Endoscopic Thoracic Discectomy in the Upper and Midthoracic Spine: A Technical Note

Cited by 38 publications

References 14 publications

Transforaminal Endoscopic Thoracic Discectomy: Technical Review to Prevent Complications

Transforaminal Endoscopic Thoracic Discectomy: Technical Review to Prevent Complications

Thoracic Endoscopic Spine Surgery: A Comprehensive Review

Safe Extraforaminal Docking and Floating Technique in Transforaminal Endoscopic Discectomy for Thoracolumbar Junction for Calcified Disc Herniation: A Case Report and Technical Review Junction for Calcified Disc Herniation

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