ABSTRACT

The indications for thoracoscopic excision of thoracic disc herniations are essentially the same as for open thoracotomy with the difference touted to be reduced approach-related morbidity. Plain radiographs provide information regarding the overall degenerative status and sagittal and coronal contour of the thoracic spine. Thoracoscopic discectomy requires general anesthesia and endotracheal intubation with a double-lumen tube for selective ventilation of the contralateral lung. The procedure begins with resection of the parietal pleura covering the medial 2 cm of the rib head and adjacent disc space. The borders of the pedicle are then defined and the pedicle is resected with a Kerrison rongeur, which exposes the lateral aspect of the thecal sac. Thoracoscopy complication rates vary by series, but the types of complications are similar to those of open thoracotomy. The most serious complications include iatrogenic neurologic deficit, pulmonary embolus, and infection.