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Full-endoscopic discectomy for thoracic disc herniations: a single-arm meta-analysis of safety and efficacy outcomes

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Abstract

Introduction

Surgical intervention is the treatment of choice in patients with thoracic disc herniation with refractory symptoms and progressive myelopathy. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. Nowadays, endoscopic techniques have become increasingly popular and full-endoscopic surgery can be performed in the thoracic spine with low complication rates.

Methods

Cochrane Central, PubMed, and Embase databases were systematically searched for studies that evaluated patients who underwent full-endoscopic spine thoracic surgery. The outcomes of interest were dural tear, myelopathy, epidural hematoma, recurrent disc herniation, and dysesthesia. In the absence of comparative studies, a single-arm meta-analysis was performed.

Results

We included 13 studies with a total of 285 patients. Follow-up ranged from 6 to 89 months, age from 17 to 82 years, with 56.5% male. The procedure was performed under local anesthesia with sedation in 222 patients (77.9%). A transforaminal approach was used in 88.1% of the cases. There were no cases of infection or death reported. The data showed a pooled incidence of outcomes as follows, with their respective 95% confidence intervals (CI)—dural tear (1.3%; 95% CI 0–2.6%); dysesthesia (4.7%; 95% CI 2.0–7.3%); recurrent disc herniation (2.9%; 95% CI 0.6–5.2%); myelopathy (2.1%; 95% CI 0.4–3.8%); epidural hematoma (1.1%; 95% CI 0.2–2.5%); and reoperation (1.7%; 95% CI 0.1–3.4%).

Conclusion

Full-endoscopic discectomy has a low incidence of adverse outcomes in patients with thoracic disc herniations. Controlled studies, ideally randomized, are warranted to establish the comparative efficacy and safety of the endoscopic approach relative to open surgery.

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Abbreviations

CI:

Confidence intervals

CSF:

Cerebrospinal fluid

FC:

Facet cyst

IntTL:

Interlaminar

JBI:

The Joanna Briggs Institute

NA:

Not available

OFL:

Ossification flavum ligament

OLLP:

Ossification ligament longitudinal posterior

PS:

Posterior stenosis

SSI:

Surgical site infection

TDH:

Thoracic disc herniation

TEP:

Transthoracic retropleural

TrSF:

Transforaminal

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Authors and Affiliations

  1. Division of Medicine, Department of Neurosurgery, Hospital of Federal University of Piaui – UFPI, Teresina, Piaui, Brazil

    Jackson Daniel Sousa Silva

  2. Division of Traumatology and Orthopedics, Department of Medicine, National Institute of Traumatology and Orthopedics – INTO, Rio de Janeiro, Brazil

    Luis E. Carelli

  3. Division of Traumatology and Orthopedics, Department of Medicine, Federal University of Ceara – UFC, Fortaleza, Ceara, Brazil

    José A. A. de Oliveira

  4. Division of Neurosurgery, Department of Medicine, University of São Paulo – USP, São Paulo, Brazil

    Ricardo M. L. de Araújo

  5. Division of Neurosurgery, University Hospital, Federal University of Piaui, University Camp Petronio Portela Minister w/n. Ininga, Teresina, Piauí, 64049–550, Brazil

    Jackson Daniel Sousa Silva

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  1. Jackson Daniel Sousa Silva
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Correspondence to Jackson Daniel Sousa Silva.

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Silva, J.D.S., Carelli, L.E., de Oliveira, J.A.A. et al. Full-endoscopic discectomy for thoracic disc herniations: a single-arm meta-analysis of safety and efficacy outcomes. Eur Spine J 32, 1254–1264 (2023). https://doi.org/10.1007/s00586-023-07595-7

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