Percutaneous Endoscopic Thoracic Discectomy: Posterolateral Transforaminal Approach

OBJECTIVE: Development of diagnostic tools has resulted in early detection of thoracic disc herniations(TDH) even when the herniated disc is soft in consistency. In some of the cases, it is considered better not to opt for surgical treatment due to the unduly high morbidity and potential complications associated with conventional approaches. The authors have applied percutaneous endoscopic thoracic discectomy(PETD) technique to soft TDHs in order to avoid the morbidity associated with conventional approaches. METHODS: Eight consecutive patients (range, 31 to 75 years) with soft lateral or central TDH (from T2-3 to T11-12) underwent PETD between May 2001 and June 2004. The patient was positioned in a prone position with intravenous sedation and local anesthetic infiltration. The authors introduced a cannula into the thoracic intervertebral foramen using endoscopic foraminoplasty technique. Discectomy was performed with mechanical tools and a laser under continuous endoscopic visualization and fluoroscopic guidance. Functional status was assessed preoperatively and postoperatively using the Oswestry Disability Index(ODI). RESULTS: The mean ODI scores improved from 52.8 before the surgery to 25.8 at the final follow-up. In cases of myelopathy, long tract signs showed improvement. The mean operative time was 55 minutes, and no patient required conversion to open surgery. CONCLUSION: The technique allows a smaller incision and less morbidity. Soft TDH is amenable to this minimally invasive approach in selected patients with myeloradiculopathy.

Surgical Treatment of Cervical Myelopathy Due to Soft Disc Herniation / 대한정형외과학회잡지

PURPOSE: To analyze the characteristics and surgical results in cervical myelopathy patients caused by soft disc herniation. MATERIALS AND METHODS: From June 1997 to August 1998. The authors treated cervical myelopathy patients who had a soft disc herniation. We evaluated the symptoms and signs, simple X-rays, the MRI, the JOA score and Hirabayashi's recovery rate. RESULTS: On simple X-ray, the narrowest A-P diameter was 13 mm, as the average was 14.9 mm, and no bony structural stenosis was found. On MRI, the average of the cord compression was 2.92 mm, and the average A-P compression ratio was 40.2%. An intermediate to high signal change in the cord was found in 8 cases. All patients improved after surgery and the average Hirabayashi's recovery rate was 61.1%. CONCLUSION: If, cord compression due to posterior soft disc herniation is severe, patients can have cervical myelopathy. Lateral disc herniation can also be a cause of cervical myelopathy. Cervical myelopathy due to soft disc herniation can be treated with a good results by using an anterior discectomy and interbody fusion method.