Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique

Thoracic disc herniation has always carried with it the potential for serious adverse neurological consequences if not treated appropriately. The authors review the historical evolution of treatment for thoracic disc herniation from the early surgical series using dorsal approaches (which were known to involve a significant risk of paraplegia) to later surgical series in which lateral and then ventral approaches to the disc were increasingly emphasized, with significant improvement in patient outcome. The evolution of minimally invasive thoracoscopic techniques is discussed, together with the results of several surgical series demonstrating significant reductions in morbidity compared with more traditional methods. The technique of thoracoscopic discectomy is presented in detail.