of minimally invasive thoracic microendoscopic discectomy while drilling the lateral facet complex. Drawing from our initial clinical application, this method has been implemented successfully to treat lateralized and central soft thoracic disc herniations causing radicular and myelopathic symptoms ( Table 1 ). The technique requires a transforaminal approach that minimizes muscle and bone dissection to reach thoracic disc lesions. The TMED was developed using instruments similar to those for microendoscopic lumbar discectomy, which involved a microendoscopic
Mick J. Perez-Cruet, Bong-Soo Kim, Faheem Sandhu, Dino Samartzis, and Richard G. Fessler
spinal cord is performed using 90° curved surgical instruments. The invasiveness of this transpedicular thoracic discectomy has been noted to be quite comparable with that of cervical or lumbar microdiscectomy. 3 In this report we include our experience with the use of an endoscope during transpedicular thoracic discectomy. Clinical Material and Methods Patient Population Between November 1993 and December 1998, 25 patients who suffered from thoracic disc protrusion underwent endoscopic transpedicular thoracic discectomy; all surgeries were performed by the
A prospective study
Jarl Rosenørn, Elisabeth Bech Hansen, and Mary-Ann Rosenørn
D uring the last three decades, the anterior approach to the cervical spine has been increasingly preferred in the operative treatment of herniated cervical discs. This approach is less traumatic 11 than the posterior technique described by Scoville, et al. , 12 among others. Two different types of operations are used, namely, discectomy without interbody fusion (DE), 1, 3, 5–9, 16 and discectomy with interbody fusion (DEF). 2, 8, 10, 13–15 When the anterior approach was first introduced, DEF was recommended, but several studies have since been published
Gregory C. Dowd and Fremont P. Wirth
demonstrated that one is better than the other. As such, both still have their proponents and detractors. 3, 4, 6, 9, 20, 21 Initial descriptions of the anterior approach for cervical discectomy all included a fusion procedure. 1, 3, 4 Concern over the possibility of developing late kyphosis from disc-space collapse or radiculopathy from foraminal narrowing supported this philosophy. However, it became clear that whereas some patients experienced relief of radicular symptoms, others developed complications related to the fusion procedure. 5 Several surgeons began to
H. August M. van Alphen, Reinder Braakman, P. Dick Bezemer, Gijs Broere, and M. Willem Berfelo
chymopapain on disc herniation was better than that of a placebo. 4, 5, 8 In recent years, the results of chemonucleolysis and surgical discectomy in patients with lumbar herniated disc have been compared on a larger scale by means of retrospective studies. 12, 22, 24 Leavitt, et al. , 10 compared open discectomy and chemonucleolysis in a prospective study of 77 patients. They found no difference between the effects of the two methods of treatment; however, the follow-up period in this study was only 14 weeks — too short a time to assess the final result of treatment
John W. German, Mathew A. Adamo, Regis G. Hoppenot, Jessin H. Blossom, and Henry A. Nagle
L umbar discectomy was first described in 1934 by Mixter and Barr. 11 Since the original description, the procedure has undergone continued refinement to limit complications and improve patient outcome. 2 , 4 , 10 , 20–22 Most recently, the use of a percutaneous, muscle-splitting, minimally invasive approach rather than a standard open, muscle-stripping approach has been described in an effort to limit approach-related complications. This latest refinement was described by Foley and Smith 4 in 1997 as a means to reduce approach-related complications
An experimental study using a synthetic tricalcium phosphate
Toshio Shima, Jeffrey T. Keller, Mariano M. Alvira, Frank H. Mayfield, and Stewart B. Dunsker
S ince the report of Robinson and Smith, 21 the anterior approach to the cervical spine has been used with increasing frequency. 17 Although satisfactory results have been reported following anterior cervical discectomy with and without interbody fusion, 13, 20, 21 many surgeons prefer the routine use of a bone graft. In some situations, such as after fracture dislocations, the use of bone grafts is desirable, 22 and it has been advocated that fresh autologous bone graft is the best implant for bone fusion. 5, 7, 13, 16, 18, 28 Robinson and Smith 21 used
Anna Kristina E. Hart, John H. Greinwald JR., Christopher I. Shaffrey, and Gregory N. Postma
R obinson and Smith 22 initially described the anterior approach for cervical discectomy and fusion in 1955. Anterior exposure of the thoracolumbar spine for fusion procedures was first described by Hodgson and Stock 13 for the treatment of Pott's disease in 1956. Since then, these anterior approaches have commonly been used in the treatment of a variety of spinal deformities. Despite the widespread popularity of anterior spine procedures, a review of the literature disclosed only nine cases of chylorrhea following anterior arthrodesis, all of which were
To reduce the invasiveness and risk of thoracic disc surgery, a transpedicular endoscopic approach has been created. The surgical technique and outcome of endoscopic transpedicular thoracic discectomy are reported.
The surgical technique of posterior transpedicular thoracic discectomy was modified to endoscopic transpedicular surgery. A 1.5-cm trocar was placed in the interlaminar space via a 2-cm transverse paramedian skin incision. At the ventral aspect of the spinal cord discectomy was performed under direct visualization by using a 70°-lens endoscope. This surgical technique was used in 25 patients. Twelve patients were men and 13 were women, aged 29 to 70 years (median 46 years). Myelopathy, with or without radiculopathy was present in 13 patients, radiculopathy in 10, and segmental pain in two. The follow-up periods ranged from 4 to 60 months (median 27 months).
In 12 of the 13 patients with myelopathy excellent improvement was shown postoperatively; the remaining patient suffered recurrence of symptoms after a motor vehicle accident three months postoperatively. In nine of the 10 patients with radiculopathy, pain was resolved completely. In one patient with right-sided hypochondral pain and two patients with segmental pain, relief was not achieved despite excellent results of discectomy demonstrated on postoperative magnetic resonance imaging. The average length of hospital stay was one night.
Endoscopic transpedicular thoracic discectomy was found to be a minimally invasive and effective surgical treatment.
Adam S. Wu and Daryl R. Fourney
published series 4 challenged this view after identifying routine discectomy-treated cases in which there were unexpected and important histopathological findings. In light of this controversy, we chose to conduct a retrospective analysis of our own experience and to review the literature. Clinical Material and Methods The final pathology report for every specimen classified as “intervertebral disc” in the Saskatoon Health Region during an 8-year period (1996–2004) was obtained from the Pathology Department database. During that time, it was health region policy to