The indications for minimally invasive spine surgery (MISS) for the treatment of thoracic disc disease have evolved and expanded over the past decade with the development of newer technologies and refined techniques. Symptomatic thoracic disc herniations are uncommon, which provides a paucity of literature exploring common surgical treatment options. The clinical presentation is highly variable, and the diagnosis is often delayed. The most common indications for thoracic discectomy include spinal cord compression with myelopathy or refractory radiculopathy.
Historical techniques for thoracic discectomy included posterior laminectomy; however, this resulted in significant morbidity and mortality given the degree of soft tissue stripping and close proximity of the thoracic cavity viscera. This drove the development of newer, minimally invasive techniques and exposures, including posterolateral, direct lateral (extracavitary), and anterolateral (transthoracic). These techniques have also been expanded to include percutaneous laser decompression with the overall aim to decrease surgical site morbidity while providing beneficially safe and reliable patient outcomes.
The purpose of this chapter is to discuss the clinical presentation, indications, techniques, outcomes, and complications of minimally invasive posterolateral, direct lateral, and anterolateral techniques for the surgical treatment of symptomatic thoracic disc herniations. Although the new techniques introduce additional learning curves and potential complications, they provide a valuable armamentarium for the treating spine surgeon to address a variety of thoracic disc herniations on a case-by-case basis.
Thoracic disc Thoracic herniated nucleus pulposus Thoracic myelopathy Thoracic discectomy Thoracoscopy Thoracoscopic discectomy Minimally invasive spine surgery MISS
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