Introduction
To demonstrate the safety and efficacy of outpatient based endoscopic thoracic discectomy
with laser thermodiskoplasty performed for symptomatic thoracic herniated nucleus pulposus.
Material and Methods
Since February 1996, 300 patients (339 discs) with symptomatic thoracic discs without
myelopathy, who failed at least 12 weeks of conservative care, were treated. The technique of percutaneous
microdecompressive endoscopic thoracic discectomy (with laser thermodiskoplasty, i.e. LTD) by posterolateral
approach is described. The thoracic disc levels were T1 to T12. All patients demonstrated a contained soft
thoracic disc herniation on MRI or CT scans. Intraoperative provacive thoracic discogram was positive and
confirmed the disc involved.
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Results
Preliminary postoperative follow-up demonstrates 96% of all patients had symptomatic relief.
There were no postoperative complications. Two patients demonstrated persistent, though reduced thoracic pain
and paresthesia. The average time to return to work was ten days for the non-worker's compensation patients.
Most of the patients received non-ablative lower laser energy application for thoracic disc shrinkage or
tightening.
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Conclusion
Percutaneous microdecompressive endoscopic thoracic discectomy with added application of
non-ablative lower Holmium laser energy for disc shrinkage (laser thermodiskoplasty) appears to be easy,
safe and efficacious. This less traumatic, easier outpatient treatment leads to excellent results, faster
recovery, and significant economic savings.
Learning Objective
The presentation provides the information for participants familiar with Endoscopic
Posterolateral Thoracic Discectomy: 1. Recognize the surgical indications. 2. The surgical technique.
3. Potential complications and avoidance.
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