Gibson Rory D S, Wagner Ralf, Gibson J N Alastair
Aberdeen Royal Infirmary, Aberdeen, UK.
Ligamenta Spine Centre, Frankfurt am Main, Germany.
EFORT Open Rev. 2021 Jan 4;6(1):50-60. doi: 10.1302/2058-5241.6.200080. eCollection 2021 Jan.
In the last five years, surgeons have applied endoscopic transforaminal surgical techniques mastered in the lumbar spine to the treatment of thoracic pathology.The aim of this systematic review was to collate the available literature to determine the place and efficacy of full endoscopic approaches used in the treatment of thoracic disc prolapse and stenosis.An electronic literature search of PubMed, Embase, the Cochrane database and Google Scholar was performed as suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis statements. Included were any full-text articles referring to full endoscopic thoracic surgical procedures in any language.We identified 17 patient series, one cohort study and 13 case reports with single or of up to three patients.Although the majority included disc pathology, 11 papers related cord compression in a proportion of cases to ossification of the ligamentum flavum or posterior longitudinal ligament. Two studies described the treatment of discitis and one reported the use of endoscopy for tumour resection.Where reported, excellent or good outcomes were achieved for full endoscopic procedures in a mean of 81% of patients (range 46-100%) with a complication rate of 8% (range 0-15%), comparing favourably with rates reported after open discectomy (anterior, posterolateral and thoracoscopic) or by endoscopic tubular assisted approaches. Twenty-one of the 31 author groups reported use of local anaesthesia plus sedation rather than general anaesthesia, providing 'self-neuromonitoring' by allowing patients to respond to cord and/or nerve stimuli. Cite this article: 2021;6:50-60. DOI: 10.1302/2058-5241.6.200080.
在过去五年中，外科医生已将在腰椎手术中掌握的内镜下经椎间孔手术技术应用于胸椎疾病的治疗。本系统评价的目的是整理现有文献，以确定全内镜手术在治疗胸椎间盘突出症和狭窄症中的地位和疗效。按照系统评价和Meta分析报告规范的建议，我们对PubMed、Embase、Cochrane数据库和谷歌学术进行了电子文献检索。纳入的文献为任何语言的涉及全内镜胸椎手术的全文文章。我们确定了17个患者系列、1项队列研究和13篇病例报告，病例数为1例或最多3例。尽管大多数文献涉及椎间盘病变，但有11篇文献报道部分病例的脊髓受压与黄韧带或后纵韧带骨化有关。两项研究描述了椎间盘炎的治疗，一项报告了内镜在肿瘤切除中的应用。据报道，全内镜手术平均在81%（范围46%-100%）的患者中取得了优良效果，并发症发生率为8%（范围0%-15%），与开放椎间盘切除术（前路、后外侧和胸腔镜）或内镜辅助管状手术报道的发生率相比具有优势。31个作者团队中有21个报告使用局部麻醉加镇静而非全身麻醉，通过让患者对脊髓和/或神经刺激做出反应来实现“自我神经监测”。引用本文：2021；6：50-60。DOI：10.1302/2058-5241.6.200080。
