Endoscopic Thoracic Discectomy

This procedure is also known as Percutaneous Endoscopic Thoracic Discectomy (PETD). It is a minimally invasive surgical treatment option for thoracic (dorsal) hernias. It is also known as posterolateral thoracic discectomy and endoscopic laser thoracic discectomy. Symptomatic thoracic disc herniations are rare, ranging from 0.25% to 0.57%, but can present with severe neurologic deficit if left untreated. In these cases, discectomy is traditionally performed through the back of the spine or by opening the thorax (transthoracic). PETD is similar to “Percutaneous Endoscopic Laser Discectomy” (PELD) performed in the neck and lumbar regions. In all these procedures, laser ablation is performed with a needle inserted through the skin into the disc. The biggest difference between PETD and other techniques is that it does not cause scar tissue and adhesions, has a low complication rate and allows early return to daily life. The procedure can be performed under local anesthesia. Other advantages are that it does not damage the bones or joints in the spine, and the spinal cord and nerves are not displaced. The number of surgeons performing this treatment is limited worldwide due to the difficult learning curve, the use of special hand tools, the high cost of the procedure and the rarity of thoracic disc herniations.

In recent years, with the advancement of surgical experience and techniques, the biportal technique (UBE surgery), which is performed through two holes, has started to be used frequently in back hernias. In the UBE technique, a camera is inserted through a small hole of 5 mm in length at the appropriate point. Subsequently, surgical instruments are advanced through the second 5 mm hole. The hernia tissue can then be removed by zooming in on the precise area in the patient’s spine with the help of the endoscope (camera). In this technique, hardened and calcified hernias that cannot be removed in PETD surgery can also be removed successfully. In our clinic, we are able to perform both procedures depending on which technique would be better for the patient’s specific case.