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Thoracic Discectomy




Thoracoscopic discectomy procedures have several distinct advantages over alternative procedures primarily related to reduced surgery-related pain, morbidity, LOS, and complications. The need for adequate training and consistant annual surgical experience to maintain effective skills are necessary for surgeons performing thoracoscopy. The alternative costotransversectomy, transpedicular, and transthoracic procedures clearly remain viable and effective techniques for surgeons experienced in these procedures and have limited experience with thoracoscopic discectomy procedures.

Thoracic Discectomy With Laser Application ?

Microdecompressive Thoracic Discectomy with Laser Application is minimally invasive spine surgery that removes a portion of the herniated disc and shrinks the herniated disc. By using local anesthesia and the help of x-ray and endoscopic guidance, the specially designed micro-instruments, a discectome, and a laser probe are inserted into the herniated disc space. A portion of the offending disc is removed with cutting, laser vaporization and suction, besides laser shrinkage of the bulging disc.

Microdecompressive thoracic discectomy is different from the standard traumatic thoracic disc surgery because there much less tissue trauma when compared to an open procedure. This minimally invasive procedure involves no muscle dissection, bone removal, bone fusion, or long incision. Therefore, many complications that can occur with conventional surgery are far less likely with this procedure.

Who Should Consider This Procedure ?

Microdecompressive thoracic discectomy is specifically designed for patients with uncomplicated, herniated discs accompanied by the following:

  1. Intractable pain radiating along the spine and chest wall
  2. Symptoms often include sensory loss, tingling, muscle spasms, and numbness
  3. A positive CT or MRI scan for disc herniation
  4. No improvement of symptoms after 8-12 weeks of conservative therapy, including physiotherapy or chiropractic treatment
  5. Positive myelogram is helpful
  6. Positive provocative discogram

The Procedure Is Not Designed For Patients With:

  1. Evidence of acute or progressive degenerative spinal cord diseases
  2. Evidence of neurological or vascular pathologies mimicking a herniated disc
  3. Evidence of advanced spondylosis (significant bony spurs) with disc space narrowing, diffuse annular bulging and other spine irregularities
  4. Evidence of significant bony spurs blocking entry to disc space
  5. Evidence of severe spinal canal or lateral recess narrowing
  6. Evidence of an extremely large extruded disc or a large free fragment of disc material
  7. Existence of other pathologies or conditions such as fractures, tumors, or active infections Only patients with clinical abnormalities confirmed by physical examination, x-rays and scans are considered for the endoscopic procedure. Tests are done prior to the procedure.

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The Procedure

The procedure is performed under local anesthesia with the patient awake and in a prone or lateral position. A small needle is inserted into the disc after local anesthesia has been administered.

Over this needle, a slightly larger introducer and a tube are inserted into disc itself. Using x-ray guidance the micro-instruments (forceps, curettes, trephines, rasps, burrs, and/or cutters), the discectome (a hollow probe with a cutting knife inside) and the laser probe are inserted into the disc space through the sleeve. Very small pieces of the disc material are removed and suctioned. The laser further shrinks the disc. The procedure takes about 30 minutes per disc, on average. X-ray exposure is minimal.

The supporting structure of the disc is not affected. Upon completion the needle is removed and a small Band-aid is applied to the tiny incision.

Postoperative Course

The patient may feel relief from pain immediately following the procedure. Walking and light exercise are usually encouraged on the next day. Some patients experience mild muscle spasms that can generally be relieved with mild analgesics.

Pain in the area of the operation is usually minimal. From the day after discharge, a daily exercise program is recommended and there is a re-evaluation examination several days later. Little, if any, postoperative medication is required for most patients. Normal activities can usually be resumed at the doctor's discretion within a few weeks.

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There are numerous advantages to microdecompressive endoscopic thoracic discectomy compared to open spinal surgery. Patients who have large free fragments of disc in the spinal canal, as determined by the x-ray, might not benefit from this procedure. However, the laser can shrink the bulging disc further for disc decompression.

Some Advantages Are:

  1. One of the advantages of the percutaneous endoscopic (arthroscopic) lumbar discectomy approach is that it is performed with much less tissue trauma when compared to an open surgical procedure.
  2. Hospitalization is not required since it is an outpatient procedure.
  3. Faster recovery since it is an outpatient procedure.
  4. Minimal to no scarring in and around the nerves post operatively.
  5. Earlier return to work and to daily activities.
  6. Patients can begin an exercise program the day after surgery.
  7. We estimate the cost of endoscopic surgery is 40% less than conventional spine surgery.

A small percentage of patients are not relieved of their pain with this procedure. There is far less risk of complications from performing microdecompressive thoracic discectomy than conventional thoracic surgery. If the endoscopic procedure is not successful, a patient can still be a candidate for open spine surgery, including fusion.

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