Minimally Invasive Procedures

Percutaneous thoracic discectomy

Treatment of a painful herniated thoracic disc is contemplated only when other measures have failed to relieve the patient’s pain. These measures include, rest, medications, physical therapy, chiropractic care and injectional therapy, wherein pain relieving medications are injected to the site of nerve irritation or compression.

Patients with a thoracic disc herniation may present with burning pain along the chest, back or upper abdomen. This is usually due to irritation of the spinal nerve as it exits the spine either by direct disc compression or inflammation. This is because a segment of disc is “herniated,” meaning migrated from its normal location or swollen beyond its normal location. Alternatively, patients with thoracic disc herniation may present with upper back pain along the middle of the back. Here the disc itself is painful, rather than compressing adjacent nerves.

Percutaneous thoracic discectomy is a minimally invasive procedure for the treatment of upper back pain or thoracic nerve pain due to herniated disk. “Percutaneous” means that the procedure is performed through a tiny skin incision. For a thoracic discectomy, a small cannula, or surgical access tube, is placed next to the spine and angled along a trajectory that intercepts the disc. This allows the cannula to travel safely through the musculature of the back, through the foramen, a natural opening in the spine, and into the disc. X-ray guidance is critical for this procedure. If too lateral, the cannula may enter the lungs. If too medial, the cannula may enter the spinal canal. Once at the disc devices are placed through the cannula to remove the diseased disc and decompress the nerves. Occasionally overgrown bone, called osteophytes, caused by arthritis has to be removed through the cannula. The procedure is guided by a scope placed through the cannula and by x-rays. In either case, the surgeon watches the images on a screen while he or she performs surgery.

A true percutaneous discectomy relies on mechanically decompressing the nerves of the spine. This means that impinging bony overgrowth or disc is physically removed using tiny instruments passed through the cannula. However, energy based ablation may be a complimentary procedure and is often performed after the discectomy. This is called laser thermodiscoplasty and involves placing a laser probe into the disc and using laser energy to liquefy residual degenerated disc and ablate, or burn, the nerves within the disc that can cause pain.

Contrary to traditional thoracic disc surgery, percutaneous thoracic discectomy usually involves only a small band aid and a single suture to the back. Because the herniated disc is approached in a minimally invasive fashion, important natural structures are not disturbed. Unlike traditional surgery, muscle is not dissected or removed from its attachments, there is no removal of uninvolved bone and important stabilizing ligaments of the back are left in place. Moreover, unlike traditional thoracic disc surgery, there is no need to open the chest to gain access to the thoracic vertebrae. Patients may, in almost all cases, go home the same day. Postoperative care will consist of rest and physical therapy.