Moraes Amato Marcelo Campos, Aprile Bruno César, Esteves Luiz Adriano, Carneiro Vinicius Marques, Oliveira Ricardo Santos de
Neurosurgeon, Amato - Instituto de Medicina Avançada, São Paulo, Brazil
Orthopedic surgeon, Clínica SOU, São Paulo, Brazil.
Int J Spine Surg. 2022 Apr;16(2):309-317. doi: 10.14444/8209.
BACKGROUND: Various approaches are used for decompressive surgeries in the thoracic spine depending on the location and consistency of the pathology, always avoiding manipulation of the thoracic spinal cord. Recently, there has been an effort to achieve adequate results and reduce morbidity with minimally invasive surgeries. Good outcomes and the advantages of full endoscopic spine surgery (FESS) have been proven for surgerical correction of herniated discs and stenoses in the lumbar and cervical spine. Similar evidence has recently been described for the thoracic spine, but it has not previously been reported in Brazil. Although the transforaminal approach is already established for the thoracic spine, the newly described interlaminar approach is equally efficient, and both techniques must be considered when treating thoracic spine diseases. The objective of the present article was to present the full endoscopic interlaminar and transforaminal techniques in patients with symptomatic disc herniation of the thoracic spine, discuss the rationality for implementing FESS in thoracic spine, and discuss the rationality in choosing between both approaches. METHODS: Two patients were submitted to thoracic FESS. A transforaminal approach was chosen for a T10-T11 foraminal disc herniation; an interlaminar approach was selected for a paramedian T7-T8 disc extrusion. Data regarding operating time, intraoperative images, hospital stay, visual analog scales before and after FESS, course of recovery, and surgery satisfaction were evaluated. RESULTS: The patients had eventless surgeries, improved from preoperative pain without morbidity. Both were satisfied and recovered well. Hospital stay was less than 6 hours after surgery. CONCLUSIONS: Transforaminal and interlaminar FESS for thoracic disc herniation are safe, efficient, and minimally invasive alternatives. CLINICAL RELEVANCE: Despite being an innovative technique with evident advantages, it should be carefully considered along with conventional technique for the treatment of thoracic spine diseases, since its clinical relevance is yet to be determined.
背景：根据病变的位置和性质，胸椎减压手术有多种方法，始终避免对胸段脊髓进行操作。近年来，人们一直在努力通过微创手术取得满意疗效并降低发病率。全内镜脊柱手术（FESS）在腰椎和颈椎间盘突出症及椎管狭窄症的手术矫正中已被证明具有良好的疗效和优势。最近也有关于胸椎的类似证据报道，但此前在巴西尚未见报道。尽管经椎间孔入路已用于胸椎手术，但新描述的经椎板间隙入路同样有效，在治疗胸椎疾病时，这两种技术都应予以考虑。本文的目的是介绍全内镜下经椎板间隙和经椎间孔技术治疗胸椎症状性椎间盘突出症患者的情况，讨论在胸椎实施FESS的合理性，以及在两种入路之间进行选择的合理性。 方法：两名患者接受了胸椎FESS手术。对于T10 - T11椎间孔型椎间盘突出症采用经椎间孔入路；对于T7 - T8旁中央型椎间盘脱出症采用经椎板间隙入路。评估了手术时间、术中影像、住院时间、FESS术前和术后的视觉模拟评分、恢复过程及手术满意度等数据。 结果：患者手术过程顺利，术前疼痛症状改善且无并发症发生。两人均感到满意且恢复良好。术后住院时间少于6小时。 结论：经椎间孔和经椎板间隙FESS治疗胸椎间盘突出症是安全、有效且微创的选择。 临床意义：尽管这是一项具有明显优势的创新技术，但在治疗胸椎疾病时，应与传统技术一起仔细考虑，因为其临床意义尚待确定。
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