Mizutani Takashi, Takebayashi Kento, Oshima Yasushi, Iwai Hiroki, Inanami Hirohiko, Koga Hisashi
Department of Orthopaedic Surgery, Iwai Orthopaedic Hospital, Tokyo, Japan.
Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan.
NMC Case Rep J. 2025 Apr 11;12:147-152. doi: 10.2176/jns-nmc.2024-0285. eCollection 2025.
Surgical treatment of thoracic disc herniation is challenging for spinal surgeons because of the kyphotic structure of the thoracic spine and the obstruction caused by the ribs and lungs during the lateral approach. In particular, highly migrating thoracic disc herniation requires the removal of surrounding structures, including the ribs, pedicles, and vertebral body. We present a case in which an upward-migrating T11/12 thoracic disc herniation was safely removed using full-endoscopic spine surgery. The patient was a 63-year-old man with sudden-onset leg pain and muscle weakness. A physical examination revealed thoracic myelopathy. Magnetic resonance imaging and computed tomography showed an upward-migrating T11/12 thoracic disc herniation without ossification or calcification. Given the severe compression of the spinal cord, a full endoscopic discectomy was performed via the posterolateral approach to relieve his myelopathy. In this study, we demonstrate surgical techniques for removing upward-migrating thoracic disc herniation using full-endoscopic spine surgery. Two important surgical techniques are emphasized: 1) Removal of the inferior and superior articular processes using a high-speed drill along the articular surface at an early stage of surgery. 2) Removal of a small caudal part of the upper vertebral body to insert forceps between the vertebral body and the posterior longitudinal ligament at a later stage of surgery. Our technique is a rapid and minimally invasive method for managing upward-migrating thoracic disc herniation without ossification.
由于胸椎的后凸结构以及侧方入路时肋骨和肺部造成的阻碍，胸椎椎间盘突出症的外科治疗对脊柱外科医生来说具有挑战性。特别是高度移位的胸椎椎间盘突出症需要切除包括肋骨、椎弓根和椎体在内的周围结构。我们报告一例使用全内镜脊柱手术安全切除向上移位的T11/12胸椎椎间盘突出症的病例。患者为一名63岁男性，突发腿痛和肌肉无力。体格检查发现胸椎脊髓病。磁共振成像和计算机断层扫描显示T11/12胸椎椎间盘向上移位，无骨化或钙化。鉴于脊髓严重受压，通过后外侧入路进行了全内镜椎间盘切除术以缓解其脊髓病。在本研究中，我们展示了使用全内镜脊柱手术切除向上移位的胸椎椎间盘突出症的手术技术。强调了两项重要的手术技术：1）在手术早期沿关节面使用高速钻切除下关节突和上关节突。2）在手术后期切除上椎体的一小部分尾侧部分，以便在椎体和后纵韧带之间插入钳子。我们的技术是一种快速且微创的方法，用于处理无骨化的向上移位的胸椎椎间盘突出症。
