2012년 10월 2일 화요일

Thoracoscopic Resection of Symptomatic Herniated Thoracic Discs (Spine 2012;37:35-40)

Clinical Case Series (Spine 2012;37:35-40)

Title
Thoracoscopic Resection of Resection of Symptomatic Herniatied Thoracic Discs
-Clinical Results in 121 Patients-

Authors
Scott D. Wait
Douglas J. Fox, Jr
Katherine J. Kenny
Curtis A. Dickman

Study Design.
Retrospective review of a prospectively maintained surgical database

Objective.
1. Report the indications, surgical procedures, outcomes
2. Compare approach-relaged complications with an unmatched cohort under going thoracotomy for HTD

Summary of Background Data.
1. Symptomatic HTDs are rare.
2. Surgical management is technically challenging.

Methods.
1. A prospectively maintained surgical database for symptomatic HTDs was reviewed.
2. A triportal method of thoracoscopic discectomy was performed in all cases.

Results.
1. F/U period: 2.4 years
2. Subjects: 121 patients/thoracoscopic-assited operations for 139 HTDs/ 46.6 years (mean age)
3. Indiations: small symptomatic disc, anterior location, nonmorbidly obese patient, favorable chest anatomy, T4-T11 location
4. Average Symptom duration: 32 months
5. Symptoms: Radiculopathy, myelopathy, pain (radiculopathic or back)
6. Mean hospital stay: 4.8 days
7. 91.1% (myelopathy), 97.6% (radiculopathy), 86.5%(back pain) improvement
8. Complication rate: acceptable (for 6years, 46 cases/ for 9 years, 75 cases)
9. Less approach-related morbidity (thoracoscopic excision) than an unmatched cohort (excision using thoracotomy)

Conclusion.
Thoracoscopic-assisted microsurgical resection is safe and effective.
This is a minimally invasive method of treating symptomatic HTDs in appropriately selected patients.
The symptoms of most patients improve or resolve with minimal morbidity.

Key Point.
1. Thoracoscopic resection is appropriate for smaller (<40% of canal area), soft, central, or paracentral symptomatic thoracic disc herniations.
2. Patients (thoracoscopic resection) need chest tubes for a shorter time with shorter hospital
stays, less blood loss, and fewer approach-related complications than in an unmatched cohort(resection via open thoracotomy).

3. Patients’ satisfaction and willingness to undergo the operation again were high (97%).
4. Myelopathy, radiculopathy, and back pain are improved or resolved at rates
of 91.1%, 97.6%, and 86.5%, respectively.


"This comes from Spine (c) 2012 Lippincott Williams & Wilkins, Inc."