Full Endoscopic Thoracic Discectomy

Symptomatic thoracic disc herniations account for less than 1% of all types of disc herniations. The upper and mid thoracic regions of the spine consist of complex neural and vascular structures which makes surgical treatment quite challenging in these regions. Conventional surgical approaches are associated with relatively higher morbidity rates. Therefore, minimally invasive spine procedures such as percutaneous endoscopic thoracic discectomy have been introduced to remove herniated discs impinging on spinal nerve roots, providing symptomatic relief.

Symptoms of thoracic disc herniation may vary with the specific area of disc herniation within the thoracic spine and the severity. Some common symptoms may include pain in the mid-back region, pain around the front region of the chest, numbness and weakness of legs, arms or both. Endoscopic thoracic discectomy procedures are equipped with an easily accessible endoscopic working channel to clearly visualize the thoracic intervertebral foramen which is comparatively smaller than the lumbar region. 

Indication of Endoscopic Thoracic Discectomy  

Percutaneous endoscopic thoracic discectomy may be indicated in the following conditions:

• Thoracic disc herniations
• Degenerative changes in thoracic spine
• Thoracic spine lesions causing progressive myelopathy
• Trauma of intervertebral discs in thoracic region
• Failed response to conservative treatment methods

Endoscopic Thoracic Discectomy procedure

Endoscopic thoracic discectomy is performed under local anesthesia and intravenous sedation. A small incision is made in the affected thoracic disc region, after which a 6-inch long spinal needle is inserted under fluoroscopic guidance. Then, a guide wire is inserted through the needle and further advanced into the intervertebral disc space.

 Next, foraminoplasty is done using a reamer or a bone drill, after which a cannula and endoscope are introduced to observe the disc material.  Initial decompression is carried out from the central and paramedian disc space, followed by ventral disc space, based on the anatomical features of the thoracic vertebrae. Once the damaged disc portion is removed and adequate decompression is achieved, the incision is finally closed with a suture and dressing. 

Advantages of Endoscopic Thoracic Discectomy

The following are some advantages of endoscopic thoracic discectomy:

• Direct access to ventral epidural space
• Higher manual dexterity for the surgeon
• Reduced risk of morbidity
• Full time visual control through endoscope
• Does not require neuromonitoring
• Lower incidence of complications