Clinical Case Series (Spine 2012;37:35-40)
Thoracoscopic Resection of Resection of Symptomatic Herniatied Thoracic Discs
-Clinical Results in 121 Patients-
Scott D. Wait
Douglas J. Fox, Jr
Katherine J. Kenny
Curtis A. Dickman
Retrospective review of a prospectively maintained surgical database
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.
1. A prospectively maintained surgical database for symptomatic HTDs was reviewed.
2. A triportal method of thoracoscopic discectomy was performed in all cases.
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)
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.
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."