Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
Centrum voor Gerechtelijke Geneeskunde, Antwerp University, Antwerp, Belgium.
Adv Tech Stand Neurosurg. 2022;45:359-378. doi: 10.1007/978-3-030-99166-1_12.
Thoracic disc herniations (TDH) may cause major morbidity. While thoracoscopic microdiscectomy (TMD) is an excellent technique, postoperative band-like pain is an important drawback.
We performed 181 consecutive TMDs (including 39 high-risk cases) with preservation of rib and costovertebral joint (CVJ). We shave a few mm of the rib, drill straight to target, and avoid opening the canal before the TDH is completely free and (in case of giant TDHs) internally debulked, creating initial decompression and limiting epidural venous oozing. Subsequently, we gently mobilize and remove the residual TDH while avoiding leverage.
Skin-to-skin time was <90' in 64, 90-120' in 48, >120' in 20, unknown in 10, and 162' mean in 39 high-risk procedures. Blood loss was <100 mL in 76, <250 mL in 48, and 537 mL mean in 39 high-risk procedures. The technique was successfully applied in all (including nine dural repairs) without a single conversion. We observed an increased neurological deficit in two (1.1%) and inadequate decompression in merely one (wrong level). Complications (mainly pulmonary) were few and managed conservatively, except for a segmental artery pseudoaneurysm treated endovascularly. We observed a substantial decrease in acute and chronic postoperative pain.
The technique is fast, straightforward, minimizes bone resection and blood loss, improves orientation, safely and effectively deals with any TDH, and prevents postoperative band-like pain as the CVJ is preserved.
We hope this technique will find broader acceptance among a new generation of spine surgeons to benefit patients suffering TDH-related myelopathy or merely intractable pain.
胸椎间盘突出症（TDH）可能导致严重的发病率。虽然胸腔镜下椎间盘切除术（TMD）是一种出色的技术，但术后带状疼痛是一个重要的缺点。
我们进行了 181 例连续的 TMD（包括 39 例高危病例），保留了肋骨和肋椎关节（CVJ）。我们切除几毫米的肋骨，直接钻孔到目标，并在 TDH 完全游离且（对于巨大的 TDH）内部切除之前避免打开管道，从而进行初步减压并限制硬膜外静脉渗血。随后，我们轻轻移动并去除残余的 TDH，同时避免使用杠杆。
皮肤到皮肤的时间<90'在 64 例中，90-120'在 48 例中，>120'在 20 例中，10 例未知，39 例高危病例的平均时间为 162'。出血量<100mL 在 76 例中，<250mL 在 48 例中，39 例高危病例的平均出血量为 537mL。该技术成功应用于所有病例（包括 9 例硬脑膜修复），无一例转换。我们观察到两名患者（1.1%）出现神经功能缺损增加，仅一名患者（错误水平）出现减压不足。并发症（主要是肺部）很少，且均保守治疗，除了一例节段性动脉假性动脉瘤采用血管内治疗。我们观察到急性和慢性术后疼痛明显减轻。
该技术快速、直接，最大限度地减少了骨切除和出血量，改善了定向性，安全有效地处理任何 TDH，并防止术后带状疼痛，因为 CVJ 得到了保留。
我们希望这项技术能够在新一代脊柱外科医生中得到更广泛的认可，使患有 TDH 相关脊髓病或仅仅是难治性疼痛的患者受益。
