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Minimally Invasive Thoracic Microendoscopic Discectomy

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Minimally Invasive Surgery in Orthopedics

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Abstract

Thoracic disc herniations present the spine surgeon with a distinctive set of challenges with regard to patient selection, surgical anatomy, and potential complications. The reported incidences of thoracic disc herniations range from 1 in 1,000 to 1 in 1,000,0001–3 and are decreased in comparison with those of their cervical and lumbar counterparts; this is likely a result of the increased rigidity of the thoracic cage, which results in a reduction in the flexion, extension, and rotation of the thoracic spine.4,5 Notwithstanding this decreased incidence and the even smaller number of patients who ultimately require surgical intervention, patients with thoracic disc herniations may present with a wide variety of symptoms. Furthermore, a multitude of surgical approaches have been developed to treat these patients, including posterior (laminectomy), posterolateral (costotransversectomy, transfacet pedicles-sparing discectomy, transpedicular discectomy, and transversoartropediculectomy), lateral (extracavitary, rachiotomy), transthoracic (transpleural, extrapleural, and transsternal), and thoracoscopic approaches. This wide spectrum of therapeutic options, coupled with the relatively low incidence of operable pathologies, is a testament to the difficulty a spine surgeon faces when attempting to treat patients with thoracic disc herniations.

Obviously each of these surgical approaches has its characteristic advantages and disadvantages. Anterior and lateral approaches, for example, allow for maximal access to the intervertebral disc and vertebral body while introducing additional risk to the thoracic contents. Conversely, posterior approaches, while inherently safer with respect to the thoracic organs, demand larger incisions and the removal of larger amounts of bone, which can result in significant blood loss, paraspinal pain, and potential mechanical instability. Whatever the chosen approach, the surgical treatment of a thoracic disc herniation risks a variety of complications. The thoracic cord does not carry as significant a risk of spinal root injury when compared with the cervical or lumbar regions; however, the thoracic spine, especially the more rostral portion, is a vascular watershed region, which leaves it susceptible to ischemic injury. In the worst cases, damage to this tenuous vascular supply can result in paraplegia.

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Authors and Affiliations

  1. Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL, 60611-3008, USA

    Kurt M. Eichholz, John E. O’Toole, Griffin R. Myers & Richard G. Fessler

Authors
  1. Kurt M. Eichholz
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  2. John E. O’Toole
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  3. Griffin R. Myers
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  4. Richard G. Fessler
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Corresponding author

Correspondence to Richard G. Fessler .

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Editors and Affiliations

  1. Insall Scott Kelly Institute, East 64th St. 210, New York, 10021, U.S.A.

    Giles R. Scuderi

  2. Orthopaedic Center of New Jersey, Route 27 1527, Somerset, 08873, U.S.A.

    Alfred J. Tria

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Eichholz, K.M., O’Toole, J.E., Myers, G.R., Fessler, R.G. (2010). Minimally Invasive Thoracic Microendoscopic Discectomy. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, New York, NY. https://doi.org/10.1007/978-0-387-76608-9_67

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  • DOI: https://doi.org/10.1007/978-0-387-76608-9_67

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