A Mini-Thoracotomy Retropleural Microdiscectomy for Thoracic Disc Herniation: A Case Report

TL;DR

A new minimally invasive surgical technique successfully treated a rare spinal condition causing severe disability in a patient.

Contribution

A novel lateral mini-thoracotomy retropleural microdiscectomy technique is proposed for thoracic disc herniation.

Findings

The procedure allowed effective decompression without spinal cord manipulation.

The patient regained walking ability post-surgery with reduced complications.

The approach offers advantages over traditional open thoracotomy.

Abstract

Symptomatic thoracic disc herniation (TDH) is relatively rare, most commonly occurring below the T8 level due to increased spinal mobility. A small herniation could cause significant spinal cord compression due to the narrow thoracic spinal canal. A 62-year-old Malay man presented with thoracic myelopathy and was unable to walk. Magnetic resonance imaging (MRI) demonstrated a large paracentral disc herniation at T9/T10 compressing the spinal cord. He underwent a lateral mini-thoracotomy retropleural microdiscectomy. Both lungs were ventilated throughout the procedure. A lateral mini-open incision measuring approximately 4-5 cm was made, and the underlying rib was segmentally resected. An exoscope was used to enhance visualization. Retropleural dissection was performed while keeping the pleura intact. Using a matchstick burr, a 1.5 × 1.5 cm box-shaped cavity was created in the posterior vertebral bodies. This cavity facilitated microdiscectomy by providing space for decompression and visualization of the ventral aspect of the spinal cord without manipulation. Intraoperatively, the herniated disc was hard and adherent to the dura, appearing chronic in nature, but was successfully removed. Postoperatively, his neurological function improved, and he regained the ability to walk. TDH is uncommon and often diagnosed late due to subtle initial symptoms and signs. Surgical decompression is indicated for patients with progressive neurological deficits. Anterior approaches allow direct access to ventral pathology without spinal cord manipulation. Mini-thoracotomy retropleural microdiscectomy offers significant advantages over open thoracotomy, including reduced blood loss, postoperative pain, pulmonary complications, hospital stay, and overall morbidity. In conclusion, a lateral mini-thoracotomy retropleural microdiscectomy offers a safe, less invasive yet effective approach to decompress the spinal cord while minimizing perioperative morbidity.

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