Journal of Korean Neurosurgical Society

  • 제40권1호
  • /
  • Pages.58-62
  • /
  • 2006
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지

Percutaneous Endoscopic Thoracic Discectomy : Posterolateral Transforaminal Approach

  • Lee, Ho-Yeon (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Kim, Dong-Yun (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Kong, Byoung-Joon (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Ahn, Yong (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Shin, Song-Woo (Department of Neurosurgery, Wooridul Spine Hospital)
  • 발행 : 2006.07.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Development of diagnostic tools has resulted in early detection of thoracic disc herniations[TDH] even when the herniated disc is soft in consistency. In some of the cases, it is considered better not to opt for surgical treatment due to the unduly high morbidity and potential complications associated with conventional approaches. The authors have applied percutaneous endoscopic thoracic discectomy[PETD] technique to soft TDHs in order to avoid the morbidity associated with conventional approaches. Methods : Eight consecutive patients [range, 31 to 75 years] with soft lateral or central TDH [from T2-3 to T11-12] underwent PETD between May 2001 and June 2004. The patient was positioned in a prone position with intravenous sedation and local anesthetic infiltration. The authors introduced a cannula into the thoracic intervertebral foramen using endoscopic foraminoplasty technique. Discectomy was performed with mechanical tools and a laser under continuous endoscopic visualization and flu oroscopic guidance. Functional status was assessed preoperatively and postoperatively using the Oswestry Disability Index[ODI]. Results : The mean ODI scores improved from 52.8 before the surgery to 25.8 at the final follow-up. In cases of myelopathy, long tract signs showed improvement. The mean operative time was 55 minutes, and no patient required conversion to open surgery. Conclusion : The technique allows a smaller incision and less morbidity. Soft TDH is amenable to this minimally invasive approach in selected patients with myeloradiculopathy.

키워드

참고문헌

  1. Adams MA, Hutton WC : Prolapsed intervertebral disc. A hyperflexion injury. 1981 Volvo Award in Basic Science. Spine 7 : 184-191, 1982 https://doi.org/10.1097/00007632-198205000-00002
  2. Ahn Y, Lee SH, Park WM, Lee HY : Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note. J Neurosurg 99 (Suppl 3) : 320-323, 2003
  3. Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY : Percutaneous endoscopic lumbar discectomy for recurrent disc herniation : surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine 29 : E326-332, 2004 https://doi.org/10.1097/01.BRS.0000109410.46538.74
  4. Arce CA, Dohrmann GJ : Thoracic disc herniation. Improved diagnosis with computed tomographic scanning and a review of the literature. Surg Neurol 23 : 356-361, 1985 https://doi.org/10.1016/0090-3019(85)90206-X
  5. Awwad EE, Martin DS, Smith KR, Baker BK : Asymptomatic versus symptomatic herniated thoracic discs : their frequency and characteristics as detected by computed tomography after myelography. Neurosurgery 28 : 180-186, 1991 https://doi.org/10.1227/00006123-199102000-00002
  6. El-Kalliny M, Tew JM, Van Loveren H, Dunsker S : Surgical approaches to thoracic disc herniations. Acta Neurochir (Wien) 111 : 22-32, 1991 https://doi.org/10.1007/BF01402509
  7. Fessler RG, Sturgill M : Review : complications of surgery for thoracic disc disease. Surg Neurol 49 : 609-618, 1998 https://doi.org/10.1016/S0090-3019(97)00434-5
  8. Isaacs RE, Podichetty VK, Sandhu FA, Santiago P, Spears JD, Aaronson O, et al : Thoracic microendoscopic discectomy : a human cadaver study. Spine 30 : 1226-1231, 2005 https://doi.org/10.1097/01.brs.0000162275.95579.ee
  9. Kim DY, Lee SH, Lee HY, Lee HJ, Chang SB, Chung SK, et al : Validation of the Korean version of the oswestry disability index. Spine 30 :E123-127, 2005 https://doi.org/10.1097/01.brs.0000157172.00635.3a
  10. Lee SH, Lim SR, Lee HY, Jeon SH, Han YM, Jung BJ : Thoracoscopic Discectomy of the Herniated Thoracic Discs. J Korean Neurosurg Soc 29 : 1577-1583, 2000
  11. Le Roux PD, Haglund MM, Harris AB : Thoracic disc disease : experience with the transpedicular approach in twenty consecutive patients. Neurosurgery 33 : 58-66, 1993 https://doi.org/10.1227/00006123-199307000-00009
  12. Nannapaneni R, Marks SM : Posterolateral thoracic disc disease : clinical presentation and surgical experience with a modified approach. Br J Neurosurg 18 : 467-470, 2004 https://doi.org/10.1080/02688690400012335
  13. Perez-Cruet MJ, Kim BS, Sandhu F, Samartzis D, Fessler RG : Thoracic microendoscopic discectomy. J Neurosurg (Spine) 1 : 58-63, 2004 https://doi.org/10.3171/spi.2004.1.1.0058
  14. Rosenthal D, Dickman CA : Thoracoscopic microsurgical excision of herniated thoracic discs. J Neurosurg 89 : 224-235, 1998 https://doi.org/10.3171/jns.1998.89.2.0224
  15. Ross JS, Perez-Reyes N, Masaryk TJ, Bohlman H, Modic MT : Thoracic disc herniation : MR imaging. Radiology 165 : 511-515, 1987 https://doi.org/10.1148/radiology.165.2.3659375
  16. Sekhar LN, Janetta PJ : Thoracic disc herniation : operative approaches and results. Neurosurgery 12 : 303-305, 1983 https://doi.org/10.1227/00006123-198303000-00009
  17. Stillerman CB, Chen TC, Day JD, Couldwell WT, Weiss MH : The transfacet pedicle-sparing approach for thoracic disc removal : cadaveric morphometric analysis and preliminary clinical experience. J Neurosurg 83 : 971-976, 1995 https://doi.org/10.3171/jns.1995.83.6.0971
  18. Williams MP, Cherryman GR, Husband JE : Significance of thoracic disc herniation demonstrated by MR imaging. J Comput Assist Tomogr 13 : 211-214, 1989 https://doi.org/10.1097/00004728-198903000-00004