Techniques for the operative management of thoracic disc herniation: minimally invasive thoracic microdiscectomy

Thoracic disc herniations are uncommon lesions that are asymptomatic in most patients; however, for individuals who present with persistent radiculopathy that is nonresponsive to conservative treatment or with myelopathic symptoms with or without radiculopathy attributed to a thoracic disc herniation, operative intervention of the thoracic spine is sought. Various procedures and approaches for the treatment of thoracic disc herniations have been reported, but they have been associated with numerous intraoperative complications and postoperative morbidities. This article discusses a novel minimally invasive procedure for the surgical treatment of thoracic disc herniations referred to as a minimally invasive thoracic microdiscectomy. It uses a series of muscle dilators, a tubular retractor, and microscopic visualization by way of a posterolateral approach in an effort to minimize many of the complications that are associated with the more traditional approaches.