THORACOSCOPIC MICROSURGICAL EXCISION OF HERNIATED THORACIC DISCS

Object. The authors began using thoracoscopy to treat pathological con ditions of the spine in 1992. In this study they delineate their clini cal experience in which this procedure was used to resect herniated th oracic discs. Methods. Fifty-five patients underwent thoracoscopy for the resection of herniated thoracic discs. Thirty-six patients present ed with myelopathies and 19 with incapacitating thoracic radicular pai n. Forty-three patients underwent a single-level, Il a two-level, and one a three-level discectomy. The mean operative time for thoracoscopi c microdiscectomy was 3 hours and 25 minutes (range 80-542 minutes) an d the mean blood loss was 327 ml (range 124-1500 ml). Compared with th oracotomy, which was performed in 18 patients, thoracoscopy was associ ated with a mean of 1 hour less operative time and less than one-half of the blood loss, duration of chest tube drainage, usage of pain medi cation, and length of hospitalization. Compared with costotransversect omy, which was performed in 15 patients, thoracoscopy permitted more c omplete resection of calcified and midline thoracic discs because it p rovided a direct view of the entire anterior surface of the dura. Thor acotomy was associated with a significantly greater incidence of prolo nged, disabling intercostal neuralgia compared with the mild transient episodes of intercostal neuralgia associated with thoracoscopy (50% c ompared with 16%). Thoracotomy also was associated with a significantl y higher incidence of postoperative atelectasis and pulmonary dysfunct ion than thoracoscopy (33% compared with 7%). Clinical and neurologica l outcomes were excellent (mean follow-up period 15 months). Among the 36 myelopathic patients, 22 completely recovered neurologically; five improved functionally but had some residual myelopathic symptoms; and nine stabilized. Among the 19 patients with isolated thoracic radicul opathies, 15 recovered completely and four improved moderately; no pat ient had worsened radicular pain. Conclusions. Thoracoscopic microdisc ectomy is a reliable surgical technique that can be performed safely w ith excellent clinical and neurological results.