Percutaneous thoracic disc decompression with laser-assisted spinal endoscopy under CT fluoroscopy guidance
Ho-Yeong Kang1, Sang-Hyeop Jeon2, Sang-Ho Lee3, Song-Woo Shin3, Ho-Yeon Lee3
1Departments of Interventional Radiology, Wooridul Spine Hospital, Seoul, Korea
2Departments of Thoracic Surgery,Wooridul Spine Hospital, Seoul, Korea
3Departments of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
Keywords: Diskectomy, percutaneous/methods; fluoroscopy/ methods; intervertebral disk displacement/surgery/radiography; thoracic vertebrae/surgery; tomography, X-ray computed.
Objectives: Thoracic discs are difficult to approach surgically. Computed tomography (CT) fluoroscopy provides accurate spatial information and real-time information. The purpose of this study is to present percutaneous thoracic disc decompression (PTDD) with laser-assisted spinal endoscopy (LASE) under CT fluoroscopy guidance as a new minimally invasive procedure for symptomatic thoracic disc herniation.
Patients and methods: Eight consecutive patients (6 males, 2 females; mean age 34.5 years; range 23 to 49 years) with intractable thoracic axial and/or radicular pain due to soft disc herniation underwent PTDD with LASE under CT fluoroscopy guidance. With the help of a live image, the ipsilateral or central portion of the protruded disc was decompressed via the posterolateral approach. All the patients were discharged in less than 24 hours. Evaluations were made with the use of the Oswestry Disability Index (ODI), a visual analog scale (VAS), and according to the modified Macnab criteria. The mean follow-up period was 16.8 months (range 13 to 21 months).
Results: The mean operating time was 65 minutes (range 45 to 90 minutes). The mean VAS score was 6.5 (range 5-8) before the procedure and 1.9 (range 0-4) at the final follow-up. The mean ODI score decreased from 55 (range 48-86) preoperatively to 16.5 (range 0-30) at the final follow-up. According to the Macnab criteria, the results were excellent in six patients (75%), good in one patient (12.5%), and fair in one patient. No postoperative complications occurred and none of the patients required open surgery.
Conclusion: In selected patients, PTDD with LASE under CT fluoroscopy guidance is an accurate, safe, and effective minimal invasive procedure for symptomatic thoracic disc herniation.