Percutaneous endoscopic thoracic discectomy; transforaminal approach

Because of the increasing use of magnetic resonance imaging (MRI), thoracic soft disc herniations are being easily detected in the early stages. To avoid a high morbidity rate and other complications that are associated with the conventional approach, the authors have applied a percutaneous endoscopic technique.

From May 2001 to July 2007, fourteen patients with soft lateral or central thoracic disc herniation (TDH) underwent percutaneous endoscopic thoracic discectomy. Under local anesthesia with intravenous sedation, the authors removed the herniated disc through the thoracic intervertebral foramen after performing a foraminoplasty, which is the enlargement of the foramen by cutting the lateral and inferior part of the superior facet with a round cutter. The clinical outcome was evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI). RESULTS Six patients were male and eight were female, aged 21-75 years (mean: 48.1 years). Mean follow-up period was 60.2 months (15-89 months), mean operative time was 61 min. The mean VAS improved from 6.5 to 3.0 for back pain and 5.8 to 2.5 for leg pain at the final follow-up. The mean ODI scores also improved from 58.1 before surgery to 24.5 at the final follow-up. Conversion to an open procedure was not required for any of the patients.

As it has been proven to lessen the morbidity rate, this percutaneous endoscopic thoracic discectomy (PETD) technique for symptomatic soft TDH is a safe and effective method that provides a direct route to the lesion under local anesthesia.