title: Minimally invasive transforaminal, thoracic microscopic discectomy: technical report and preliminary results and complications.
abstract: BACKGROUND
  Surgical decompression of thoracic disc herniations is technically challenging because retraction of the thecal sac in this area must be avoided. Standard open thoracic discectomy procedures require fairly extensive soft tissue dissection and vertebral resection to provide safe decompression of the spinal cord.
  
  
  OBJECTIVE
  To describe our experience using a minimally invasive, transforaminal thoracic discectomy (MITTD) technique for the treatment of thoracic disc herniation.
  
  
  METHODS
  Technical report and preliminary results and complications.
  
  
  METHODS
  Twelve patients undergoing MITTD were evaluated preoperatively and postoperatively at 1-, 3-, and 6-month intervals with neurologic examination, and were graded using the American Spinal Injury Association (ASIA) impairment scale and a pain visual analog scale (VAS). Thoracic instability and bony fusion were assessed clinically and radiographically with plain radiographs and computed tomography (CT) scans. Surgical time, blood loss, complications, and hospital length of stay were recorded.
  
  
  RESULTS
  Twelve patients (seven men and five women) underwent MITTD. The median surgical time was 128 (80 to 185) minutes, the median estimated blood loss was 100 (30 to 250) mL, and the median hospital stay was 2 (1 to 4) nights. All discs were successfully removed, and a CT or magnetic resonance imaging confirmed adequate cord decompression in all cases. All patients reported easing of neurologic symptoms and improved walking ability. The median VAS scores improved from 4.5 to 2 for back pain. The ASIA score improved from D to E in the two patients who suffered from motor weakness. Preoperative sensory deficit was reduced in three of the five patients. Patients who suffered from sexual and urinary disturbances did not report improvement. Serious systemic or local complications and neurologic deterioration were not reported.
  
  
  CONCLUSIONS
  The transforaminal approach enabled sufficient access to the midline of the spinal canal without extensive resection of the facet joint or the adjacent pedicle. Because most of the osseous and ligamentous structures were preserved, additional instrumentation was not required to prevent postoperative instability. Our early results suggested that minimally invasive thoracic discectomy by transforaminal microscopic technique is a valuable choice in the management of thoracic disc herniation.
authors.affiliation: Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, 6 Weitzman St., Tel Aviv 64239, Israel. giladre@tlvmc.gov.il
authors.forename: Gilad J
authors.initials: GJ
authors.lastname: Regev
authors.forename: Khalil
authors.initials: K
authors.lastname: Salame
authors.forename: Eyal
authors.initials: E
authors.lastname: Behrbalk
authors.forename: Ory
authors.initials: O
authors.lastname: Keynan
authors.forename: Zvi
authors.initials: Z
authors.lastname: Lidar
mesh_terms: D000328:Adult; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology*; D013904:Thoracic Vertebrae