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Minimally invasive thoracic microendoscopic diskectomy: surgical technique and case series
Justin S Smith1, Kurt M Eichholz, Stephen Shafizadeh
1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
Objective:
To present operative details and clinical follow-up of a series of patients with thoracic disk herniation treated with the minimally invasive technique of thoracic microendoscopic diskectomy (TMED).
Methods:
TMED was performed in 16 consecutive patients (age range, 18-79 years old) with 18 thoracic disk herniations. One patient with a calcified herniation in a direct ventral location was not included in this series. Patients were positioned prone, and a tubular retractor system was placed through a muscle dilating approach. The procedure was performed with endoscopic visualization. Outcomes were assessed using modified McNab criteria.
Results:
There were no complications, and no case required conversion to an open procedure. The mean operative time was 153 minutes per level, and mean blood loss was 69 mL per level. Mean hospital stay was 21 hours. At a mean follow-up of 24 months (median, 22 months), 13 patients (81%) had excellent or good outcomes, 1 patient (6%) had a fair outcome, and 2 patients (13%) had poor outcomes. The two patients with poor outcomes had neurologic diagnoses (multiple sclerosis and multiple systems atrophy) that were ultimately found to be responsible for their symptoms and deficits.
Conclusions:
TMED is a safe and effective minimally invasive posterolateral approach for the treatment of thoracic disk herniations that lacks the morbidity associated with traditional approaches.
Insights
Thoracic microendoscopic diskectomy (TMED) offers a safe and effective minimally invasive surgical option for thoracic disk herniation. This technique demonstrates good clinical outcomes with low complication rates.
Area of Science:
- Neurosurgery
- Minimally Invasive Spine Surgery
Background:
- Thoracic disk herniations are challenging spinal pathologies.
- Traditional open approaches carry significant morbidity.
Purpose of the Study:
- To detail the operative technique and clinical outcomes of thoracic microendoscopic diskectomy (TMED).
- To evaluate TMED as a minimally invasive treatment for thoracic disk herniation.
Main Methods:
- TMED was performed on 16 patients with 18 thoracic disk herniations.
- The posterolateral approach utilized endoscopic visualization and a tubular retractor system.
- Outcomes were assessed using modified McNab criteria at a mean follow-up of 24 months.
Main Results:
- No complications or conversions to open surgery were reported.
- Mean operative time was 153 minutes/level, with 69 mL blood loss/level.
- 81% of patients achieved excellent or good outcomes; mean hospital stay was 21 hours.
Conclusions:
- TMED is a safe and effective minimally invasive posterolateral approach for thoracic disk herniation.
- This technique avoids the morbidity associated with traditional open surgeries.
