Full-endoscopic Discectomy for the Treatment of Thoracic Myelopathy Caused by Upward-migrating Thoracic Disc Herniation

Abstract

Surgical treatment of thoracic disc herniation is challenging for spinal surgeons because of the kyphotic structure of the thoracic spine and the obstruction caused by the ribs and lungs during the lateral approach. In particular, highly migrating thoracic disc herniation requires the removal of surrounding structures, including the ribs, pedicles, and vertebral body. We present a case in which an upward-migrating T11/12 thoracic disc herniation was safely removed using full-endoscopic spine surgery. The patient was a 63-year-old man with sudden-onset leg pain and muscle weakness. A physical examination revealed thoracic myelopathy. Magnetic resonance imaging and computed tomography showed an upward-migrating T11/12 thoracic disc herniation without ossification or calcification. Given the severe compression of the spinal cord, a full endoscopic discectomy was performed via the posterolateral approach to relieve his myelopathy. In this study, we demonstrate surgical techniques for removing upward-migrating thoracic disc herniation using full-endoscopic spine surgery. Two important surgical techniques are emphasized: 1) Removal of the inferior and superior articular processes using a high-speed drill along the articular surface at an early stage of surgery. 2) Removal of a small caudal part of the upper vertebral body to insert forceps between the vertebral body and the posterior longitudinal ligament at a later stage of surgery. Our technique is a rapid and minimally invasive method for managing upward-migrating thoracic disc herniation without ossification.