Thoracoscopic discectomy for herniated thoracic discs
Sang-Hyeop Jeon1, Sang-Ho Lee2, Song-Woo Shin2
1Departments of Thoracic Surgery, Wooridul Spine Hospital, Seoul, Korea
2Departments of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
Keywords: Diskectomy/methods; endoscopy/methods; intervertebral disk displacement/surgery/radiography; thoracic vertebrae/surgery; tomography, X-ray computed.
Objectives: Thoracoscopic discectomy is a relatively new and technically demanding minimally invasive procedure. In this study, we presented our clinical experience with thoracoscopic discectomy.
Patients and methods: The medical records of 49 consecutive patients (30 men, 19 women; mean age 48.5 years; range 28 to 68 years) who underwent thoracoscopic discectomy from March 1997 to October 2004 were retrospectively reviewed. All the patients suffered from myelopathy (n=44) or intolerable radiculopathy (n=5). The mean follow-up period was 52 months (range 3 to 94 months).
Results: Preoperative radiologic studies showed soft disc herniation in 21 patients and hard calcified disc herniation in 32 patients. The most common involvement was at T6-7 with nine patients (18.4%), followed by T8-9 with six patients (12.2%), and T3-4 (n=5, 10.2%), T7-8 (n=5), T9-10 (n=5), and T10-11 (n=5). The mean operation time was 182 minutes (range 100 to 420 minutes). The mean blood loss was 340 ml (range 150 to 1,500 ml). Of 44 patients with myelopathy, 41 patients (93.2%) showed neurologic improvement, and three patients (6.8%) had a stabilized neurological status. All the patients with radiculopathy had complete recovery. Postoperative complications included intercostal neuralgia, delayed hemopneumothorax, prolonged air leakage, and pneumonia in four patients, respectively.
Conclusion: Although the learning curve is steep, thoracoscopic discectomy is a safe and effective minimally invasive procedure for symptomatic thoracic disc herniations.