Dr. Jho's Minimally Invasive Back Surgery For Thoracic Disc Herniation: Minimally Invasive Endoscopic Transpedicular Thoracic Discectomy

Outpatient Surgery

Hae Dong Jho, M.D., Ph.D.

He who asks is a fool for five minutes, but he who does not ask remains a fool forever. - Chinese Proverb

Facts About This Surgery

• Combines the minimally invasive transpedicular approach with endoscopic technology
• Is less invasive because it bypasses the need for postoperative chest tube drainage which the transthoracic approach requires
• Is innovative because it offers an effective alternative to the extensive conventional procedures
• Allows direct visualization of the front part of the spinal cord
• Can be done on an overnight basis
• Has proven to be effective in relieving the band-like radiating pain that often accompanies thoracic disc herniations

Discussion

This very minimally invasive procedure combines the transpedicular approach to thoracic discs with the technology of endoscopic surgery. Using the transpedicular approach provides the surgeon an alternative to the extensive posterolateral approach, and to the thoracotomy approach which is open chest surgery. Utilizing an endoscope, which improves visualization much like the periscope of a submarine or the rear-view-mirror on an automobile does, further enhances the transpedicular approach in accomplishing the goal of successful disc resection. This provides the patient with a better chance of having the symptoms of pain or leg weakness resolved. The use of an endoscope and a less invasive surgical approach also leads to decreased postoperative complications. This surgery is usually done on an overnight basis.

Definitions

transpedicular - across one of the two bony columns of the vertebral neural arch

Images

Schematic drawings demonstrate a patient's positioning, and line of a skin incision.

             

Removal of the protruded disc under 70-degree endoscopic visualization. C: the spinal cord, D: the protruded disc.

              

Sequential intraoperative endoscopic images demonstrate disc removal. C: the spinal cord, D: the protruded disc

             

MR scans, axial view, depict a protruded disc preoperatively (left, arrow) and its complete removal postoperatively (right). The bright signal in the postoperative image represents the surgical trajectory. The spinal cord is well decompressed (right, arrow).

             

Left: A preoperative MRI scan showing a herniated thoracic disc (arrow)

Right: The corresponding postoperative MRI showing removal of the herniated portion of disc. The spinal cord is well decompressed (arrows).

Reference

Jho, HD: Microscopic endoscopic thoracic discectomy via transpedicular approach: Technical note. Journal of Neurosurgery 87: 125-129,1997