Full-Endoscopic Transforaminal Approach With Partial Pediculectomy for a Central Thoracic Disc Herniation: Technical...

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery
• Spinal Endoscopy

Background:

• Thoracic disc herniations (TDHs) are uncommon (<1% of all herniations) but can cause significant neurological deficits.
• Traditional open/mini-open discectomies carry high morbidity (pulmonary issues, fusion needs).
• Full-endoscopic discectomy presents an ultra-minimally invasive alternative, though challenging for midline/calcified TDHs.

Purpose of the Study:

• To present a case of successful full-endoscopic transforaminal discectomy for a central, calcified thoracic disc herniation.
• To highlight strategies for managing complex thoracic disc herniations using endoscopic techniques.
• To evaluate the safety and efficacy of endoscopic approaches for thoracic disc pathology.

Main Methods:

• A 54-year-old male with a T6-T7 central disc herniation underwent outpatient right-sided full-endoscopic transforaminal discectomy.
• The procedure involved lateralized access, controlled bony resection, and angled instrumentation.
• No spinal cord retraction or manipulation was required for complete decompression.

Main Results:

• Complete decompression of the spinal cord was achieved.
• The patient experienced full resolution of preoperative chest wall pain and lower-extremity hyperreflexia.
• The patient was discharged home within 2 hours post-procedure, demonstrating rapid recovery.

Conclusions:

• Full-endoscopic transforaminal discectomy is a safe and effective option for selected central TDHs.
• Endoscopic approaches significantly reduce complication rates, blood loss, hospital stay, and costs compared to open surgery.
• Advanced endoscopic expertise and careful patient selection are crucial for successful outcomes in thoracic disc herniations.