Endoscopic surgery of the thoracic spine
Overview of endoscopic thoracic spine surgery
Endoscopic surgery of the thoracic spine is done
> under local and/or general anesthesia
> with a skin incision of less than 10 mm length in the back
> with much less invasiveness than any other open surgery (i.e. costo-transversectomy)
> does NOT require insertion of implants or devices and fusing the thoracic spine
> does NOT need a post-operative stay at the ICU, even if multiple levels are operated on at the same time
> does NOT require complete resection or partial of a rib and a vertebral body (corpectomy) nor deflating a lung (like in open surgery)
> mantiene la movilidad de la columna dorsal
> El dolor suele comenzar a remitir a las pocas horas de la operación
> Es una cirugía ambulatoria con deambulación a las pocas horas de la operación
> Permite al paciente regresar a su domicilio antes de 24 horas tras la operación
Endoscopic surgery of the thoracic spine allows treating
> Thoracic disk herniation of any size, location and complexity
> Thoracic disk protusions
> Thoracic disk annular tears
> Thoracic disk impingement
> Foraminal stenosis of the thoracic spine
> Central canal stenosis with and without spinal cord compression in the thoracic spine
> mielopatía dorsal
> afectación de los nervios intercostales dorsales
> dolor intercostal irradiado al pecho o al abdomen
> y otras muchas patologías de la columna dorsal y torácica
The pathologies of the thoracic spine
Thoracic disk herniations are the less frequent ones (less than 3% of all herniations requiring surgery) but with the most challenging surgery.
A thoracic disk herniation can cause chronic and intense back pain, most of the time between the shoulder blades (scapulae), also known as interscapular pain.
Additionally, thorac disk herniations can cause one-sided (unilateral) or even two-sided (bilateral) radiating pain into a rib (intercostal pain) and/or into the belly,
This image shows an MRI scan of the thoracic spine showing a right foraminal thoracic disk herniation (marked in a red circle) at level Th8/Th9.
The most severe cases of a thoracic disk herniation can cause spinal cord compression, which can lead to neurologic sympotms, like i.e. muscle weakness in the lower limbs, tingling and/or numbness in the legs, bladder dysfunction and/or incontinence, severe constipation, etc.), loss of control of the lower limbs with unstable walking (ataxia) and if the damage to the spinal cord is prolonged in time, it may even lead to muscle weakness, especially in the legs and paraplegia.
Standard open surgery of the thoracic spine
The classic, open surgery of the thoracic spine is a highly invasive and aggressive surgery also known as costo-transversectomy. This is a lateral approach to the thoracic spine that requires a complete resection and extraction of a rib to access the thoracic cavity. Once the lung is exposed, it needs to be deflated and pushed aside to be able to access the thoracic spine. In most cases, to remove a thoracic disk herniation, a (partial) corpectomy, i.e. the complete/partial removal of a vertebral body, is required which leeds to instability of the thoracic spine. Cconsequently, once the procedure is complete, implants need to be placed to stabilize the thoracic spine.
Open surgery of the thoracic spine is complex and very invasive, and therefore patients are at high risk of suffering complications and co-morbidities,, i.e high risk of bleeding requiring blood transfusions, risk of developing a neumothorax (air inside the thoracic cavity that compresses the lungs) that requires to place a drainage near the lungs for several days, risk of losing up to 20% of lung capacity due to adhesions and scarring of the lung, long post-operative stays at the ICU, prolonged stay in the hospital for several weeks and the necessity of going through a comprehensive back and respiratory rehabilitation program after surgery.
Picture of an MRI image showing a central thoracic disk herniation (marked with a red circle) at thoracic disk level Th7/Th8
For all these reasons, open thoracic spine surgery is usually restricted to emergency settings in which patients are suffering from neurologic damage with risk of a spinal cord injury and/or muscle weakness/paraplegia.
This video shows an endoscopic surgery of the thoracic spine using an endoscopic transforaminal approach on a female patient that presented with upper back pain between the scapulae and radiating intercostal pain to the right chest caused by thoracic disk herniation at level Th8/Th9 .
What are the advantages of endoscopic thoracic spine surgery?
The introduction of endoscopic surgery of the thoracic spine has supposed a complete revolution in the treatment of thoracic disk herniations.
The endoscopic approach of the lumbar spine does NOT require accessing the thoracic cavity, hence it is not requiring manipulation of a rib and/or the lungs. Given its ultra minimally-invasive nature, endoscopic spine surgery allows solving thoracic disk herniations with a skin incision of less than 1 cm length and hospital discharge in less than 24 hours after surgery. Endoscopic surgery of the thoracic spine does not require an ICU stay as soft tissue is preserved, facilitating a speedy recovery with early ambulation/walking a few hours after surgery.
Post-operative photo showing the scar (marked in a red circle) in the upper back of a patient 1 week after endoscopic thoracic spine surgery.
Thus, endoscopic spine surgery of the thoracic spine is a complete change in paradigm in the treatment of thoracic disk herniations, as it allows ambulatory treatment of any kind and size of thoracic disk herniations, including small foraminal thoracic disk herniations up to giant calcified thoracic disk herniations.
