Thoracic Brochure

Introduction
Mid-back pain can be the price human beings pay for frequent bending and twisting, high-speed accidents, falls, and degenerative disc disease. It can be painful and disabling.

Thoracic disc herniation occurs less frequently than lumbar and cervical disc herniation. Often, thoracic disc pain fails to respond to conservative treatment and the patient lives with discomfort. In many cases, simple treatments such as heat, physiotherapy, rest, exercise, and pain medication bring relief. Other sufferers are not so fortunate. If one or more of their vertebral discs ruptures and presses on the nerve roots, the pain radiating along the chest and spine can be incapacitating and severe.

For many, the only treatment is surgical removal of part of the herniated disc, which in the past has required a major traumatic operation. Traditional thoracic discectomy requires general anesthesia, the dissection of muscle and removal of bone, and bone fusion. Thoracic discs are difficult to approach surgically because of the ribs, the narrow spinal canal, the nearby lung, and the critical position of the spinal cord. Open thoracic surgery involves a traumatic approach that often requires entry through the chest, resectioning of ribs and part of the vertebral body, collapsing of the lung, and often bone fusion and metal plate screws. This results in a high risk of spinal cord injury or other traumatic complications. A long post-surgical hospitalization and recuperation are needed for this traumatic surgery.

Now there is a much less traumatic procedure for some patients with disc problems known as a Microdecompressive endoscopic thoracic discectomy with laser application, an outpatient procedure.

What is Microdecompressive Endoscopic Thoracic Discectomy with Laser Application?
Microdecompressive Thoracic Discectomy with Laser Application is minimally invasive spine surgery that removes a portion of the herniated disc and shrinks the herniated disc. By using local anesthesia and the help of x-ray and endoscopic guidance, the specially designed micro-instruments, a discectome, and a laser probe are inserted into the herniated disc space. A portion of the offending disc is removed with cutting, laser vaporization and suction, besides laser shrinkage of the bulging disc.

Microdecompressive thoracic discectomy is different from the standard traumatic thoracic disc surgery because there much less tissue trauma when compared to an open procedure. This minimally invasive procedure involves no muscle dissection, bone removal, bone fusion, or long incision. Therefore, many complications that can occur with conventional surgery are far less likely with this procedure.

Who Should Consider This Procedure?
Microdecompressive thoracic discectomy is specifically designed for patients with uncomplicated, herniated discs accompanied by the following:

1. Intractable pain radiating along the spine and chest wall
2. Symptoms often include sensory loss, tingling, muscle spasms, and numbness
3. A positive CT or MRI scan for disc herniation
4. No improvement of symptoms after 8-12 weeks of conservative therapy, including physiotherapy or chiropractic treatment
5. Positive myelogram is helpful
6. Positive provocative discogram

The procedure is not designed for patients with:

1. Evidence of acute or progressive degenerative spinal cord diseases
2. Evidence of neurological or vascular pathologies mimicking a herniated disc
3. Evidence of advanced spondylosis (significant bony spurs) with disc space narrowing, diffuse annular bulging and other spine irregularities
4. Evidence of significant bony spurs blocking entry to disc space
5. Evidence of severe spinal canal or lateral recess narrowing
6. Evidence of an extremely large extruded disc or a large free fragment of disc material
7. Existence of other pathologies or conditions such as fractures, tumors, or active infections

Only patients with clinical abnormalities confirmed by physical examination, x-rays and scans are considered for the endoscopic procedure. Tests are done prior to the procedure.

The Procedure
The procedure is performed under local anesthesia with the patient awake and in a prone or lateral position. A small needle is inserted into the disc after local anesthesia has been administered.

Over this needle, a slightly larger introducer and a tube are inserted into disc itself. Using x-ray guidance the micro-instruments (forceps, curettes, trephines, rasps, burrs, and/or cutters), the discectome (a hollow probe with a cutting knife inside) and the laser probe are inserted into the disc space through the sleeve. Very small pieces of the disc material are removed and suctioned. The laser further shrinks the disc. The procedure takes about 30 minutes per disc, on average. X-ray exposure is minimal.

The supporting structure of the disc is not affected. Upon completion the needle is removed and a small Band-aid is applied to the tiny incision.

Postoperative Course
The patient may feel relief from pain immediately following the procedure. Walking and light exercise are usually encouraged on the next day. Some patients experience mild muscle spasms that can generally be relieved with mild analgesics.

Pain in the area of the operation is usually minimal. From the day after discharge, a daily exercise program is recommended and there is a re-evaluation examination several days later. Little, if any, postoperative medication is required for most patients. Normal activities can usually be resumed at the doctor's discretion within a few weeks.

Advantages
There are numerous advantages to microdecompressive endoscopic thoracic discectomy compared to open spinal surgery. Patients who have large free fragments of disc in the spinal canal, as determined by the x-ray, might not benefit from this procedure. However, the laser can shrink the bulging disc further for disc decompression. Some advantages are:

1. One of the advantages of the percutaneous endoscopic (arthroscopic) lumbar discectomy approach is that it is performed with much less tissue trauma when compared to an open surgical procedure.
2. Hospitalization is not required since it is an outpatient procedure.
3. Faster recovery since it is an outpatient procedure.
4. Minimal to no scarring in and around the nerves post operatively.
5. Earlier return to work and to daily activities.
6. Patients can begin an exercise program the day after surgery.
7. We estimate the cost of endoscopic surgery is 40% less than conventional spine surgery.

A small percentage of patients are not relieved of their pain with this procedure. There is far less risk of complications from performing microdecompressive thoracic discectomy than conventional thoracic surgery. If the endoscopic procedure is not successful, a patient can still be a candidate for open spine surgery, including fusion.

Summary
Microdecompressive thoracic discectomy with laser application requires no hospitalization and usually leads to earlier return to work and to previous daily activities. A small percentage of patients do not get relief of symptoms. Rare patient complications include mild muscle spasms and transient pain. Patients who initially have obtained good results often remain pain free.

If you have any questions concerning this procedure, please feel free to further discuss them with us.