Video-assisted thoracoscopic treatment of discogenic thoracic myelopathy

Background. Clinically significant herniated intervertebral discs in the thoracic spine are quite rare, and the tactics of surgical treatment of a group of patients with this pathology remains debatable. The thoracoscopic technique has a number of advantages in the form of a shorter hospital stay and less severe pain in the surgical area compared to standard posterior surgical access.

Aim. To evaluate the results of videothoracoscopic treatment of patients with discogenic thoracic myelopathy.

Material and methods. The article analyzes the results of treatment of 21 patients hospitalized at the Federal Neurosurgical Center (Novosibirsk). According to the results of the examination, the patients were divided into 2 groups: with mild (10 patients) or ossified (11 patients) hernias. Each patient underwent video‑assisted thoracoscopic microdiscectomy. The median follow‑up was 29 (4 to 72) months.

Results. At the time of discharge, 18 (85.7 %) patients showed no deterioration in neurological status, 2 (9.5 %) patients showed positive dynamics in the form of a decrease in the degree of hypertonicity and the degree of lower paraparesis. A satisfactory result of treatment in the late postoperative period was achieved in 14 (66.7 %) patients.

Conclusion. Video‑assisted thoracoscopic surgery is an effective and safe method of surgical treatment of patients with discogenic thoracic myelopathy.

1. Kerezoudis P., Rajjoub K.R., Goncalves S. et al. Anterior versus posterior approaches for thoracic disc herniation: Association with postoperative complications. Clin Neurol Neurosurg 2018;167: 17–23. DOI: 10.1016/j.clineuro.2018.02.009

2. Anand N., Regan J.J. Video-assisted thoracoscopic surgery for thoracic disc disease: Classification and outcome study of 100 consecutive cases with a 2-year minimum follow-up period. Spine (Phila Pa 1976) 2002;27(8):871–9. DOI: 10.1097/00007632200204150-00018

3. Lewis R.J., Caccavale R.J., Sisler G.E. Special report: video-endoscopic thoracic surgery. N J Med 1991;88(7):473–5. PMID: 1891124

4. Oskouian R.J., Johnson J.P., Regan J.J. Thoracoscopic Microdiscectomy. Neurosurgery 2002;50(1):103–9. DOI: 10.1097/00006123-200201000-00018

5. Quint U., Bordon G., Preissl I. et al. Thoracoscopic treatment for single level symptomatic thoracic disc herniation: a prospective followed cohort study in a group of 167 consecutive cases. Eur Spine J 2012;21(4):637–45. DOI: 10.1007/s00586-011-2103-0

6. Ayhan S., Nelson C., Gok B. et al. Transthoracic surgical treatment for centrally located thoracic disc herniations presenting with myelopathy: a 5-year institutional experience. J Spinal Disord Techn 2010;23(2):79–88. DOI: 10.1097/BSD.0b013e318198cd4d

7. Slynko E.I., Zolotoverkh A.M., Gurina I.I., Ternitskaya Yu.P. Features of computed tomography when planning surgical treatment of hernias of the thoracic spine. Ukrainskij nejroxirurgicheskij zhurnal = Ukrainian Neurosurgical Journal 2011;1:56–9. (In Russ.)

8. Grin A.A., Oschepkov S.K., Kaikov A.K., Krylov V.V. Video endoscopic surgery of injuries and diseases of the thoracic and lumbar spine / Ed. by V.V. Krylov. M.: Print Studio, 2012. 152 p.

9. R Core Team. R: A language and environment for statistical computing. (Electronic resource). R Foundation for Statistical Computing, Vienna, Austria. 2021.

10. Court C., Mansour E., Bouthors C. Thoracic disc herniation: Surgical treatment. Orthop Traumatol Surg Res 2018;104(1):S31–S40. DOI: 10.1016/j.otsr.2017.04.022

11. Foreman P.M., Naftel R.P., Moore T.A. 2nd, Hadley M.N. The lateral extracavitary approach to the thoracolumbar spine: a case series and systematic review. J Neurosurg Spine 2016;24(4):570–9. DOI: 10.3171/2015.6.SPINE15169

12. Simonovich A.E. Surgery of herniated thoracic intervertebral discs: a systematic review of the English literature. Xirurgiya pozvonochnika = Spine Surgery 2019;16(1):70–80. (In Russ.) DOI: 10.14531/ss2019.1.70-80

13. Grin A.A., Zhestkov K.G., Kaikov A.K. et al. Videothoracoscopic operations for injuries and diseases of the thoracic spine. Nejroxirurgiya = Russian Journal of Neurosurgery 2010;3:36–44. (In Russ.).

14. Regan J.J., Ben-Yishay A., Mack M.J. Video-assisted thoracoscopic excision of herniated thoracic disc: description of technique and preliminary experience in the first 29 cases. J Spinal Disord 1998;11(3):183–91. PMID: 9657540.