Transthoracic Video Assisted Endoscopic Discectomy

Jongsoo Park, MD
Chinyere Obasi, MD (Los Angeles, CA)
Michael S. Hahn, MD (New York, NY)
J. Patrick Johnson, MD (Los Angeles, CA)

Introduction:

The video–assisted endoscopic discectomy procedure for thoracic disc herniation has been evolving for the past several years. The procedure is a minimally invasive technique that accomplishes the same surgical goal as the open technique. A retrospective evaluation of outcome and morbidity from 3 years experience was undertaken.

Methods:

Thirty–three patients were treated for symptomatic thoracic disc herniation causing radiculopathy and/or myelopathy. Ages ranged from 39–78 years, and duration of symptoms was 2–10 months. Average operating room time was 4.3 hours and no postoperative ICU stay was required. Hospital stay was 2.3 and 4.3 days, respectively, for the patients with radiculopathy and myelopathy.

Results:

Nineteen patients had radiculopathy. Fifteen had resolved symptoms and other four had improved symptoms. Fourteen patients had myelopathy. All had variable improvement except one was unchanged and two patients were worse. One patient underwent open thoracotomy later the same year for recurrence at the same level and two other symptomatic thoracic disc herniations. Complications included one post–operative pneumonia, and one patient had a persistent intercostal neuralgia.

Conclusions:

The recent development of transthoracic endoscopic disc surgery has become feasible and effective procedure. Long term outcome for this series has essentially the same results as historical cohorts for open procedures, however, morbidity and hospital stay are significantly reduced. Although, these procedures are technically challenging with a difficult learning curve, the efficacy is clearly validated.