Thoracoscopic resection of symptomatic herniated thoracic discs: Cinical results in 121 patients

Scott D. Wait, Douglas J. Fox, Katherine Kenny, Curtis A. Dickman

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Study Design: Retrospective review of a prospectively maintained surgical database. Objective: To report the indications, surgical procedures performed, and outcomes from the largest series of thoracoscopically treated herniated thoracic discs (HTDs). We also compared approach-related complications with an unmatched cohort undergoing thoracotomy for HTD. Summary of Background Data: Symptomatic HTDs are rare, and their surgical management is technically challenging. Methods: A prospectively maintained surgical database of all patients undergoing surgery for symptomatic HTDs by the senior author (blinded for review) was reviewed. As needed, the database was supplemented with hospital and clinic charts and telephone conversations with patients. A triportal method of thoracoscopic discectomy was performed in all cases. Results: Between 1994 and 2008, 121 patients underwent 125 thoracoscopic-assisted operations for 139 HTDs. Their mean age at surgery was 46.6 years. Indications for thoracoscopic resection currently include small symptomatic disc, anterior location, nonmorbidly obese patient, favorable chest anatomy, and T4-T11 location. Symptom duration averaged 32 months. Radiculopathy was the most common presentation, followed by myelopathy and pain (radiculopathic or back). The mean hospital stay was 4.8 days. Chest tubes remained in place for a mean of 3.2 days. At a mean follow-up of 2.4 years, myelopathy, radiculopathy, and back pain had resolved or improved at a rate of 91.1%, 97.6%, and 86.5%, respectively. Patients reported worsening in 0%, 1.2%, and 0% of cases, respectively. Most patients (97.4%) would be willing to undergo the operation again. The complication rate was acceptable. Patients undergoing thoracoscopic excision had less approach-related morbidity than an unmatched cohort undergoing excision using thoracotomy. Conclusion: Thoracoscopic-assisted microsurgical resection is a safe, effective, and minimally invasive method of treating symptomatic HTDs in appropriately selected patients. The symptoms of most patients improve or resolve with minimal morbidity.

Original languageEnglish (US)
Pages (from-to)35-40
Number of pages6
JournalSpine
Volume37
Issue number1
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

Fingerprint

Intervertebral Disc Displacement
Thorax
Radiculopathy
Spinal Cord Diseases
Databases
Thoracotomy
Morbidity
Diskectomy
Chest Tubes
Back Pain
Telephone
Length of Stay
Anatomy
Retrospective Studies
Pain

Keywords

  • endoscopic spine surgery
  • herniated thoracic disc
  • thoracic discectomy
  • thoracoscopic discectomy
  • thoracoscopy

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Thoracoscopic resection of symptomatic herniated thoracic discs : Cinical results in 121 patients. / Wait, Scott D.; Fox, Douglas J.; Kenny, Katherine; Dickman, Curtis A.

In: Spine, Vol. 37, No. 1, 01.01.2012, p. 35-40.

Research output: Contribution to journalArticle

Wait, Scott D. ; Fox, Douglas J. ; Kenny, Katherine ; Dickman, Curtis A. / Thoracoscopic resection of symptomatic herniated thoracic discs : Cinical results in 121 patients. In: Spine. 2012 ; Vol. 37, No. 1. pp. 35-40.
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AB - Study Design: Retrospective review of a prospectively maintained surgical database. Objective: To report the indications, surgical procedures performed, and outcomes from the largest series of thoracoscopically treated herniated thoracic discs (HTDs). We also compared approach-related complications with an unmatched cohort undergoing thoracotomy for HTD. Summary of Background Data: Symptomatic HTDs are rare, and their surgical management is technically challenging. Methods: A prospectively maintained surgical database of all patients undergoing surgery for symptomatic HTDs by the senior author (blinded for review) was reviewed. As needed, the database was supplemented with hospital and clinic charts and telephone conversations with patients. A triportal method of thoracoscopic discectomy was performed in all cases. Results: Between 1994 and 2008, 121 patients underwent 125 thoracoscopic-assisted operations for 139 HTDs. Their mean age at surgery was 46.6 years. Indications for thoracoscopic resection currently include small symptomatic disc, anterior location, nonmorbidly obese patient, favorable chest anatomy, and T4-T11 location. Symptom duration averaged 32 months. Radiculopathy was the most common presentation, followed by myelopathy and pain (radiculopathic or back). The mean hospital stay was 4.8 days. Chest tubes remained in place for a mean of 3.2 days. At a mean follow-up of 2.4 years, myelopathy, radiculopathy, and back pain had resolved or improved at a rate of 91.1%, 97.6%, and 86.5%, respectively. Patients reported worsening in 0%, 1.2%, and 0% of cases, respectively. Most patients (97.4%) would be willing to undergo the operation again. The complication rate was acceptable. Patients undergoing thoracoscopic excision had less approach-related morbidity than an unmatched cohort undergoing excision using thoracotomy. Conclusion: Thoracoscopic-assisted microsurgical resection is a safe, effective, and minimally invasive method of treating symptomatic HTDs in appropriately selected patients. The symptoms of most patients improve or resolve with minimal morbidity.

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KW - thoracoscopy

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