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.
Symptomatic thoracic disc herniations are rare and their management is complex. The outcomes of thoracoscopic-assisted resection are excellent. In most cases, the presenting symptoms of patients improve or resolve. Patient satisfaction is high.
*Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ;
†NeuroTexas Institute, St. David's Medical Center, Austin, TX.
Address correspondence and reprint requests to Curtis A. Dickman, MD, c/o Neuroscience Publications, Barrow Neurological Institute, 350 W Thomas Rd, Phoenix, AZ 85013; E-mail: firstname.lastname@example.org
Acknowledgment date: August 24, 2010. First revision date: December 20, 2010. Acceptance date: December 21, 2010.
The manuscript submitted does not contain information about medical device(s)/drug(s).
No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Curtis A. Dickman is a consultant, direct stockholder, and receives other financial support from Medtronic and DePuy.