Posterolateral full-endoscopic uniportal foraminotomy and discectomy for central hard thoracic disc herniation – A case report and literature review

摘要

Endoscopic spine surgery was popularized in the degenerate lumbar spine where it rapidly established its role as a minimally invasive way to effectively address symptomatic disc herniations in selected patients. As familiarity with the technique has grown, so too has its extended indications. Thoracic disc herniations were once considered too formidable for endoscopic removal due to them often being central and calcified. For these patients, an anterolateral trans-pleural approach was advocated as the only way to directly address the anterior thecal compression, at the expense of the morbidity from undergoing some form of associated thoracotomy. The last 10-years has seen a conceptual shift away from the anterior approaches altogether, and an exciting new development in the field is the posterolateral full-endoscopic uniportal thoracic foraminotomy and discectomy, which exclusively uses the thoracic intervertebral foramen to access the thoracic spinal canal and remove symptomatic disc. While conceptually logical, applying this novel technology to a central calcified disc in the tight thoracic spinal canal almost completely occupied by the spinal cord, is not to be undertaken by novice surgeons. We report a case of an adult male patient who presented to our unit in an early myelopathic state secondary to a central calcified thoracic disc herniation. Utilizing this novel technique, we were able to relieve the spinal cord compression and report a favorable outcome. As the realm of endoscopic spinal surgery expands, so too will reports of extended indications. Over time these extended indications coalesce, until what was once thought to be impossible, ultimately becomes the standard of care.