Patient number 9 had another herniation at T6-7, for which she was suggested to have another surgery. Despite the poor ODI scores at the final followup, when asked if they would consider the same surgery again if necessary in the future, all of sellckchem the three patients said yes. This suggests that our technique is well accepted by the patients. Compared with traditional surgical treatment, our endoscopic transforaminal technique offers a few advantages. Small incision and minimal bone removal reduce postoperative pain and ensure fast recovery. Local anesthesia enhances safety and further shortens the recovery. And excellent visualization provided by the endoscope ensures adequate decompression of the nerve. Moreover, same-day surgery with no need for hospital stay significantly reduces the total treatment cost.
The low complication rate (0.08%, 1 of 13) and high patient self-reported satisfactory rate (76.9%) suggest that the technique is safe and effective in treating symptomatic soft thoracic disc herniation. However, like all other surgical techniques, our technique also has limitations. First, the technique is not indicated for sequestrated thoracic disc herniation. And it is extremely challenging to remove large central herniations in patients with severe spinal stenosis. Patients with these conditions are generally referred to surgeons specializing in performing traditional open spine surgery, or thoracotomy. Because the thoracic spinal cord is highly susceptible to injury due to the anatomical nature of the thoracic spine, our technique requires the surgeon to have great surgical skills and considerable amount of experience with endoscopic surgery.
5. Conclusions For carefully selected patients, endoscopic transforaminal thoracic discectomy and foraminotomy is a safe and effective treatment option for symptomatic soft thoracic disc herniation. Conflict of Interests The authors have no conflict of interests or financial ties to disclose. Acknowledgment The authors thank Dr. Yanni Wang for assisting in revising the paper.
Although widely used in the lumbar and lower thoracic spine, the minimally invasive approach is still limited in the treatment of the upper thoracic spine disease. The principal issue regarding treatment of thoracic spinal disorders through a minimally invasive approach is the potential for resulting neurologic injuries. The high risk of devastating complications is probably the primary roadblock to a wider use of the percutaneous approach to the thoracic spine. Anatomic peculiarities and difficult clear visualization under fluoroscopy of the pedicles of the upper thoracic spine GSK-3 make percutaneous screw fixation a demanding procedure especially when multilevel thoracic fixation is required.