Percutaneous Endoscopic Thoracic Discectomy : Posterolateral Transforaminal Approach
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.
- 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
- 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
- Le Roux PD, Haglund MM, Harris AB : Thoracic disc disease : experience with the transpedicular approach in twenty consecutive patients. Neurosurgery 33 : 58-66, 1993
- Nannapaneni R, Marks SM : Posterolateral thoracic disc disease : clinical presentation and surgical experience with a modified approach. Br J Neurosurg 18 : 467-470, 2004
- Rosenthal D, Dickman CA : Thoracoscopic microsurgical excision of herniated thoracic discs. J Neurosurg 89 : 224-235, 1998
- 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
- Williams MP, Cherryman GR, Husband JE : Significance of thoracic disc herniation demonstrated by MR imaging. J Comput Assist Tomogr 13 : 211-214, 1989
- 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
- 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
- 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
- El-Kalliny M, Tew JM, Van Loveren H, Dunsker S : Surgical approaches to thoracic disc herniations. Acta Neurochir (Wien) 111 : 22-32, 1991
- Sekhar LN, Janetta PJ : Thoracic disc herniation : operative approaches and results. Neurosurgery 12 : 303-305, 1983
- Perez-Cruet MJ, Kim BS, Sandhu F, Samartzis D, Fessler RG : Thoracic microendoscopic discectomy. J Neurosurg (Spine) 1 : 58-63, 2004
- 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
- Adams MA, Hutton WC : Prolapsed intervertebral disc. A hyperflexion injury. 1981 Volvo Award in Basic Science. Spine 7 : 184-191, 1982
- Fessler RG, Sturgill M : Review : complications of surgery for thoracic disc disease. Surg Neurol 49 : 609-618, 1998
- 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
- Ross JS, Perez-Reyes N, Masaryk TJ, Bohlman H, Modic MT : Thoracic disc herniation : MR imaging. Radiology 165 : 511-515, 1987
저자의 다른 논문
- 2005 "Discogenic Abdominal Pain" Journal of Korean Neurosurgical Society = 대한신경외과학회지 38 (5): 384~386
- 2005 "Lumbar Corpectomy by Using Anterior Midline Route" Journal of Korean Neurosurgical Society = 대한신경외과학회지 38 (5): 399~402
- 2005 "Isthmic Spondylolisthesis Associated with Foraminal Disc Herniation Treated by Anterior Lumbar Interbody Fusion" Journal of Korean Neurosurgical Society = 대한신경외과학회지 38 (4): 320~322
- 2005 "L1-2 Disc Herniations : Clinical Characteristics and Surgical Results" Journal of Korean Neurosurgical Society = 대한신경외과학회지 38 (3): 196~201
- 2005 "Multi-access for the Diagnosis of Missed Upper Lumbar Disc Herniation" Journal of Korean Neurosurgical Society = 대한신경외과학회지 38 (2): 144~146
- 2005 "Early Stress Fracture of the Pelvic Ring Following Proximal Extension of an Instrumented Lumbosacral Fusion to Treat Junctional Kyphosis" Journal of Korean Neurosurgical Society = 대한신경외과학회지 38 (1): 77~79
- 2005 "The Morphometric Analysis of the Extraforamen in the Lumbosacral Spine: Magnetic Resonance Imaging and Computed Tomography Study" Journal of Korean Neurosurgical Society = 대한신경외과학회지 37 (5): 336~339
- 2005 "The Influence of Fixation Rigidity on Intervertebral Joints - An Experimental Comparison between a Rigid and a Flexible System" Journal of Korean Neurosurgical Society = 대한신경외과학회지 37 (5): 364~369
- 2005 "The Triple Entrapment Syndrome of the 5th Lumbar Spinal Nerve" Journal of Korean Neurosurgical Society = 대한신경외과학회지 37 (4): 258~262
- 2006 "Anterior Lumbar Interbody Fusion with Pedicle Screw Fixation for Elderly Isthmic Spondylolisthesis" Journal of Korean Neurosurgical Society = 대한신경외과학회지 40 (3): 175~179
- NDSL :
- 대한신경외과학회 : 저널
- 원문이 없습니다.
유료 다운로드의 경우 해당 사이트의 정책에 따라 신규 회원가입, 로그인, 유료 구매 등이 필요할 수 있습니다. 해당 사이트에서 발생하는 귀하의 모든 정보활동은 NDSL의 서비스 정책과 무관합니다.
원문복사신청을 하시면, 일부 해외 인쇄학술지의 경우 외국학술지지원센터(FRIC)에서
무료 원문복사 서비스를 제공합니다.
NDSL에서는 해당 원문을 복사서비스하고 있습니다. 위의 원문복사신청 또는 장바구니 담기를 통하여 원문복사서비스 이용이 가능합니다.
- 이 논문과 함께 출판된 논문 + 더보기