Thoracoscopic Microdiscectomy with Preservation of Rib and Costovertebral Joint

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Spine Surgery

Background:

• Thoracic disc herniations (TDH) can lead to significant patient morbidity.
• Postoperative band-like pain is a notable drawback of conventional thoracoscopic microdiscectomy (TMD).

Purpose of the Study:

• To present a modified TMD technique that preserves the rib and costovertebral joint (CVJ).
• To evaluate the efficacy and safety of this modified TMD technique in treating TDH.

Main Methods:

• 181 consecutive TMD procedures were performed, preserving the rib and CVJ.
• A specific surgical approach involving minimal rib shaving and avoiding early canal opening was employed.
• Techniques for internal debulking of giant TDHs were utilized to minimize venous oozing and facilitate gentle removal.

Main Results:

• The technique was successfully applied in all cases, including complex ones requiring dural repair, with no conversions.
• Low rates of neurological deficit (1.1%) and inadequate decompression (0.55%) were observed.
• A significant reduction in both acute and chronic postoperative pain was noted, alongside minimal blood loss and bone resection.

Conclusions:

• The modified TMD technique is efficient, straightforward, and minimizes surgical trauma.
• Preservation of the CVJ effectively prevents postoperative band-like pain.
• This technique offers a safe and effective solution for various TDH presentations, potentially improving patient outcomes.