Transcostal Microendoscopic Discectomy for Central Thoracic Disc Herniation Causing Myelopathy: A Technical Note

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery
• Spinal Cord Surgery

Background:

• Minimally invasive treatment of thoracic disc herniation (TDH) with myelopathy is challenging due to difficult access and spinal cord fragility.
• The posterior-lateral approach is often used, but reaching central herniations requires specialized techniques.

Purpose of the Study:

• To present a novel transcostal microendoscopic discectomy (TCMED) procedure for central TDH causing myelopathy.
• To evaluate the safety and efficacy of the TCMED approach.

Main Methods:

• The TCMED procedure involves a posterior-lateral approach with a microendoscope and rib resection for access.
• The herniated disc is identified and removed by drilling the ventral side of the disc.
• The procedure was performed on three male patients under general anesthesia in the prone position.

Main Results:

• The average operative time was 237.7 minutes with an average blood loss of 26.7 mL.
• The average modified Japanese Orthopedic Association score improved from 5.2/11 preoperatively to 9.5/11 postoperatively (75.6% recovery rate).
• The 10-second step test improved significantly, and no serious complications or residual rib pain were reported.

Conclusions:

• The TCMED approach allows safe access to the thoracic spine via rib landmarks without thoracotomy.
• This technique enables safe and effective resection of central TDH without spinal cord retraction.
• TCMED is a viable minimally invasive option for treating central TDH with myelopathy.