Minimally invasive, extracavitary approach for thoracic disc herniation: technical report and preliminary results

BackgroundTraditional approaches to thoracic disc herniation are technically demanding and, if incorporating thoracotomy, can be associated with significant morbidity. New procedures have allowed discectomy with less pain and morbidity.PurposeTo assess the feasibility, safety, and early outcome of a minimally invasive extracavitary approach (MI-ECA) for thoracic disc disease.Study designCadaver sessions and a short-term human study were performed on four cadavers and 10 patients, respectively. Operative results and complications were studied, and early outcome was assessed using a Visual Pain Analog Scale, neurological status, and American Spinal Injury Association (ASIA) classification.MethodsFour fresh cadaver sessions, attempting all thoracic levels, were completed to determine the feasibility of the technique. Ten patients with thoracic myelopathy caused by herniated disc were treated using the minimally invasive extracavitary approach.ResultsIntervertebral discs were successfully removed from all four cadavers using this procedure. No operative complications in the human series were documented. The mean operative time was 171 minutes (150–220), mean estimated blood loss was 215 cc (60–350), and hospital stay for all patients was one night. No operative or postoperative complications were encountered. All patients returned to work within 4 weeks after discharge. Postoperative ASIA scores improved in three patients who had motor or sensory findings. Tone improved in all patients. Mean pain outcome using the Visual Pain Analog Scale was 1.5 (0–3).ConclusionOur early experience suggests that MI-ECA may be a valuable option in the management of thoracic disc herniation.