Chapter 24 Endoscopy-Assisted Thoracic Microdiscectomy
Historically, spinal surgeons have sought to find a surgical procedure of choice to treat thoracic disc herniations [1–14]. The threat of spinal cord, neural, vascular, and pulmonary injuries has stimulated many attempted approaches, including posterior laminectomy (seldom performed because it is too likely to result in neurologic injury), costotransversectomy, transthoracic, transpleural, posterolateral, transfacet pedicle-sparing, transpedicular, and, more recently, transthoracic endoscopic and posterolateral endoscopic procedures [4,5,11–17].
Many clever, minimally invasive surgical endoscopic thoracic procedures, including video-assisted thoracic surgery (VATS) [1,2,4,5] and thoracic sympathectomy, have been developed in an attempt to reduce operative trauma. Endoscopy-assisted thoracic discectomy (EATD) (i.e., posterolateral endoscopic thoracic discectomy) is an alternative procedure for treating symptomatic herniated thoracic discs through an endoscope to cause less tissue trauma than current conventional thoracic disc surgery and thoracoscopic procedures [5,11–21]. In laser thermodiscoplasty, tissue modulation technology of a lower-energy non-ablative laser is applied for shrinkage and tightening of the disc [5,10–15,18].
A significant number of patients with thoracic disc herniations complain of intractable thoracic spinal and paraspinal pain, intercostal or chest wall pain, upper abdominal pain, and, occasionally, low back pain due to thoracic disc protrusions without severe neurologic deficit. With improved diagnostic methods such as magnetic resonance imaging (the method of choice), computed tomography myelograms, and computed tomography scans, the diagnosis of these thoracic disc herniations or protrusions is now far more common [5,11–15]. Usually, patients with such conditions undergo some period of physical therapy, injection therapy, and analgesics, but if these treatments are not effective, the patients are often expected to live with their discomfort because of the fear of the potentially severe postoperative complications associated with surgical treatment [5,11–15].
Treatment objective of endoscopy-assisted thoracic discectomy
Indications
The indications for EATD are as follows [5,11–16]:
Contraindications
EATD is contraindicated by the following findings or conditions [5,11–16]:
Advantages
The advantages of EATD over open procedures are as follows:
Instrumentation
The following instruments and equipment are needed for EATD: