Posterior video-assisted trans pedicular surgery for calcified midline thoracic disc herniation.

Autor:	Sasani M; Koc University School of Medicine, Neurosurgery Department, Turkey; American Hospital, Neurosurgery Department, Turkey., Sasani H; Namik Kemal University, Faculty of Medicine, Radiology Department, Turkey., Akgun MY; Koc University School of Medicine, Neurosurgery Department, Turkey. Electronic address: myigitakgun@gmail.com., Hekimoglu M; American Hospital, Neurosurgery Department, Turkey., Basak AT; American Hospital, Neurosurgery Department, Turkey., Oktenoglu T; Koc University School of Medicine, Neurosurgery Department, Turkey; American Hospital, Neurosurgery Department, Turkey., Ates O; Koc University School of Medicine, Neurosurgery Department, Turkey., Ozer AF; Koc University School of Medicine, Neurosurgery Department, Turkey; American Hospital, Neurosurgery Department, Turkey.
Jazyk:	angličtina
Zdroj:	Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association [J Orthop Sci] 2024 Feb 07. Date of Electronic Publication: 2024 Feb 07.
DOI:	10.1016/j.jos.2024.01.009
Abstrakt:	Background: In the treatment of patients with calcified midline thoracic disc herniation (CMTDH), the posterior video-assisted transpedicular surgery (VATPS) technique is employed. Both anterior and posterior surgical approaches for treating CMTDH carry a significant risk of surgical complications and potential morbidity. This technical note introduces a surgical procedure that avoids the drawbacks associated with these approaches. Methods: The VATPS technique presents a comprehensive approach for treating thoracic disc herniation, combining both microscopic and endoscopic stages. The microscopic phase entails a small thoracoscopic incision, muscle release, hemilaminotomy, facet joint resection, and vertebra removal, culminating in creating a corpectomy cavity for endoscope access. Careful separation of adhesions between the dura and ligaments marks this stage. Transitioning to the endoscopic phase, an endoscope is inserted into the cavity, allowing for precise visualization and separation of residual adhesions, removal of calcified disc fragments using specialized instruments, and ensuring complete discectomy. Results: Fourteen patients underwent VATPS for CMTDH. During the procedure, evoked responses were reduced in one patient. However, no postoperative neurological deficits were observed. We also noted significant improvements in the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) scores when comparing the preoperative and postoperative assessments. Conclusion: VATPS, a minimally invasive technique, offers excellent anterior visibility comparable to that of the anterolateral approach, all while avoiding the adverse effects associated with thoracotomies and the complications resulting from spinal cord encroachment often seen in the posterolateral approach. Moreover, it is a safer alternative to conventional endoscopic posterior thoracic surgery. The cavity formed within the vertebral corpus provides ample working space for the use of an endoscope. Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2024 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)
Databáze:	MEDLINE
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