title: Minimally invasive thoracic microendoscopic diskectomy: surgical technique and case series.
abstract: OBJECTIVE
  To present operative details and clinical follow-up of a series of patients with thoracic disk herniation treated with the minimally invasive technique of thoracic microendoscopic diskectomy (TMED).
  
  
  METHODS
  TMED was performed in 16 consecutive patients (age range, 18-79 years old) with 18 thoracic disk herniations. One patient with a calcified herniation in a direct ventral location was not included in this series. Patients were positioned prone, and a tubular retractor system was placed through a muscle dilating approach. The procedure was performed with endoscopic visualization. Outcomes were assessed using modified McNab criteria.
  
  
  RESULTS
  There were no complications, and no case required conversion to an open procedure. The mean operative time was 153 minutes per level, and mean blood loss was 69 mL per level. Mean hospital stay was 21 hours. At a mean follow-up of 24 months (median, 22 months), 13 patients (81%) had excellent or good outcomes, 1 patient (6%) had a fair outcome, and 2 patients (13%) had poor outcomes. The two patients with poor outcomes had neurologic diagnoses (multiple sclerosis and multiple systems atrophy) that were ultimately found to be responsible for their symptoms and deficits.
  
  
  CONCLUSIONS
  TMED is a safe and effective minimally invasive posterolateral approach for the treatment of thoracic disk herniations that lacks the morbidity associated with traditional approaches.
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia. Electronic address: jss7f@virginia.edu.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Kurt M
authors.initials: KM
authors.lastname: Eichholz
authors.forename: Stephen
authors.initials: S
authors.lastname: Shafizadeh
authors.forename: Alfred T
authors.initials: AT
authors.lastname: Ogden
authors.forename: John E
authors.initials: JE
authors.lastname: O'Toole
authors.forename: Richard G
authors.initials: RG
authors.lastname: Fessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002114:Calcinosis / Q000601:surgery; D017586:Diskectomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000209:etiology / Q000601:surgery; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009422:Nervous System Diseases / Q000150:complications; D019635:Neurosurgical Procedures / Q000379:methods*; D016684:Prone Position; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult