Clinical study of percutaneous endoscopic thoracic spine surgery via trench technique for thoracic spinal cord ventral decompression_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Tao , DENG Rui , CHENG Si , YAN Zhengjian ,  DENG Zhongliang ,  YU Qingshuai

Department of Spine Surgery Center, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P. R. China;

Corresponding author：

DENG Zhongliang, Email: zhongliang.deng@qq.com; YU Qingshuai, Email: yuqingshuai817@qq.com

Keywords：

Central calcified thoracic disc herniation; thoracic ossification of the posterior longitudinal ligament; percutaneous thoracic endoscopy; trench technique; ventral spinal cord decompression

DOI：

10.7507/1002-1892.202406086

Video：

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Objective To evaluate the feasibility, safety, and early effectiveness of percutaneous endoscopic thoracic spine surgery via the trench technique for ventral decompression in central calcified thoracic disc herniation (CCTDH) and thoracic ossification of the posterior longitudinal ligament (T-OPLL). Methods Seven patients with single-segment CCTDH or T-OPLL admitted between June 2017 and May 2020 and meeting the selection criteria were retrospectively analyzed. There were 3 males and 4 females with an average age of 51.7 years ranging from 41 to 62 years. There were 2 patients with T-OPLL (T_{1, 2} in 2 cases) and 5 patients with CCTDH (T_{1, 2} in 1 case, T_{7, 8} in 1 case, T_{10, 11} in 2 cases, T_{11, 12} in 1 case). Five patients with thoracic axial pain and intercostal neuralgia had a preoperative visual analogue scale (VAS) score of 6.0 (5.0, 6.5), and 7 patients had a preoperative Japanese Orthopaedic Association (JOA) score of 21 (21.0, 22.0). Transforaminal approach was used in 4 cases and transpedicular approach in 3 cases. Ventral decompression of thoracic spinal cord was performed by thoracic endoscopy combined with trench technique. The operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications were recorded. Thoracic spine CT and MRI were performed preoperatively and postoperatively to evaluate the surgical decompression, VAS score was used to evaluate the pain of thoracic back and lower limbs, and JOA score was used to evaluate the functional recovery. Modified MacNab criteria was used to evaluate the effectiveness. Results All surgeries were successfully completed. The operation time ranged from 60 to 100 minutes, with an average of 80.4 minutes; the intraoperative blood loss ranged from 40 to 75 mL, with an average of 57.1 mL; the postoperative hospital stay ranged from 4 to 7 days, with an average of 5.4 days. CT and MRI examinations indicated that the decompression was adequate. All 7 patients were followed up 3-22 months, with an average of 13.3 months. One case developed postoperative wound infection, and 1 case developed pneumonia; the remaining patients did not have any complications such as wound infection or cerebrospinal fluid leakage. Five patients with thoracic axial pain and intercostal neuralgia had VAS scores of 2.0 (1.5, 2.5) at 1 day after operation and 2.0 (1.0, 2.0) at last follow-up, both of which were significantly lower than the preoperative scores (P<0.05). At 1 day after operation, the JOA scores for all 7 patients were 22.0 (21.0, 24.0), which showed no significant difference compared to the preoperative score (P>0.05); however, at last follow-up, the score improved to 24.0 (24.0, 26.0), which was significant compared to the preoperative scores (P<0.05). At last follow-up, the effectiveness was assessed using the modified MacNab criteria, the results were excellent in 2 cases, good in 3 cases, fair in 2 cases, and the excellent and good rate was 71.4%.Conclusion Using the trench technique, percutaneous endoscopic thoracic spine surgery can achieve the ventral decompression in CCTDH and T-OPLL, providing a new approach for surgical treatment of CCTDH and T-OPLL.

1.	McInerney J, Ball PA. The pathophysiology of thoracic disc disease. Neurosurg Focus, 2000, 9(4): e1. doi: 10.3171/foc.2000.9.4.2.
2.	Arce CA, Dohrmann GJ. Thoracic disc herniation. Improved diagnosis with computed tomographic scanning and a review of the literature. Surg Neurol, 1985, 23(4): 356-361.
3.	Stillerman CB, Chen TC, Couldwell WT, et al. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg, 1998, 88(4): 623-633.
4.	Currier BL, Eismont FJ, Green BA. Transthoracic disc excision and fusion for herniated thoracic discs. Spine (Phila Pa 1976), 1994, 19(3): 323-328.
5.	Belanger TA, Roh JS, Hanks SE, et al. Ossification of the posterior longitudinal ligament. Results of anterior cervical decompression and arthrodesis in sixty-one North American patients. J Bone Joint Surg (Am), 2005, 87(3): 610-615.
6.	Koda M, Furuya T, Okawa A, et al. Mid- to long-term outcomes of posterior decompression with instrumented fusion for thoracic ossification of the posterior longitudinal ligament. J Clin Neurosci, 2016, 27: 87-90.
7.	Tang R, Shu J, Li H, et al. Surgical technique modification of circumferential decompression for thoracic spinal stenosis and clinical outcome. Br J Neurosurg, 2023, 37(3): 503-506.
8.	Kong W, Ao J, Cao G, et al. Local spinal cord decompression through a full endoscopic percutaneous transcorporeal approach for cervicothoracic ossification of the posterior longitudinal ligament at the T₁-T₂ level. World Neurosurg, 2018, 112: 287-293.
9.	Takahata M, Ito M, Abumi K, et al. Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine (Phila Pa 1976), 2008, 33(11): 1199-1208.
10.	Yamazaki M, Mochizuki M, Ikeda Y, et al. Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion. Spine (Phila Pa 1976), 2006, 31(13): 1452-1460.
11.	Yu KX, Chu L, Chen L, et al. A novel posterior trench approach involving percutaneous endoscopic cervical discectomy for central cervical intervertebral disc herniation. Clin Spine Surg, 2019, 32(1): 10-17.
12.	Liao C, Ren Q, Chu L, et al. Modified posterior percutaneous endoscopic cervical discectomy for lateral cervical disc herniation: the vertical anchoring technique. Eur Spine J, 2018, 27(6): 1460-1468.
13.	Chu L, Yang JS, Yu KX, et al. Percutaneous endoscopic retrieval of intraspinal cement leakage: Technical note. World Neurosurg, 2018, 118: 150-155.
14.	Abiola R, Rubery P, Mesfin A. Ossification of the posterior longitudinal ligament: Etiology, diagnosis, and outcomes of nonoperative and operative management. Global Spine J, 2016, 6(2): 195-204.
15.	Awwad EE, Martin DS, Smith KR, et al. Asymptomatic versus symptomatic herniated thoracic discs: their frequency and characteristics as detected by computed tomography after myelography. Neurosurgery, 1991, 28(2): 180-186.
16.	Faciszewski T, Winter RB, Lonstein JE, et al. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine (Phila Pa 1976), 1995, 20(14): 1592-1599.
17.	王凯, 刘晓光, 祝斌, 等. “涵洞塌陷法”360° 胸脊髓环形减压术后短暂脊髓功能损伤加重的相关危险因素分析及预后. 中国矫形外科杂志, 2014, 22(22): 2028-2033.
18.	Ahn Y. Current techniques of endoscopic decompression in spine surgery. Ann Transl Med, 2019, 7(Suppl 5): S169. doi: 10.21037/atm.2019.07.98.
19.	Rosenthal D. Endoscopic approaches to the thoracic spine. Eur Spine J, 2000, 9 Suppl 1(Suppl 1): S8-S16.
20.	Deng ZL, Chu L, Chen L, et al. Anterior transcorporeal approach of percutaneous endoscopic cervical discectomy for disc herniation at the C₄-C₅ levels: a technical note. Spine J, 2016, 16(5): 659-666.
21.	Liu C, Liu K, Chu L, et al. Posterior percutaneous endoscopic cervical discectomy through lamina-hole approach for cervical intervertebral disc herniation. Int J Neurosci, 2019, 129(7): 627-634.
22.	Li ZZ, Hou SX, Shang WL, et al. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up. Clin Neurol Neurosurg, 2016, 143: 90-94.
23.	Choi KY, Eun SS, Lee SH, et al. Percutaneous endoscopic thoracic discectomy; transforaminal approach. Minim Invasive Neurosurg, 2010, 53(1): 25-28.
24.	Wagner R, Telfeian AE, Iprenburg M, et al. Transforaminal endoscopic solution to a kyphoplasty complication: Technical note. World Neurosurg, 2016, 91: 195-198.
25.	Wagner R, Telfeian AE, Iprenburg M, et al. Transforaminal endoscopic foraminoplasty and discectomy for the treatment of a thoracic disc herniation. World Neurosurg, 2016, 90: 194-198.
26.	Ruetten S, Hahn P, Oezdemir S, et al. Full-endoscopic uniportal decompression in disc herniations and stenosis of the thoracic spine using the interlaminar, extraforaminal, or transthoracic retropleural approach. J Neurosurg Spine, 2018, 29(2): 157-168.
27.	Ruetten S, Hahn P, Oezdemir S, et al. Operation of soft or calcified thoracic disc herniations in the full-endoscopic uniportal extraforaminal technique. Pain Physician, 2018, 21(4): E331-E340.
28.	Yu Q, Shi L, Xu Z, et al. Therapeutic effectiveness of percutaneous endoscopic spinal surgery for intraspinal cement leakage following percutaneous vertebroplasty: An early clinical study of 12 cases. Pain Physician, 2020, 23(4): E377-E388.
29.	于庆帅, 邓瑞, 石磊, 等. 后路经皮脊柱内镜垂直锚定联合战壕技术治疗单节段中央型颈椎间盘突出症. 中国修复重建外科杂志, 2021, 35(5): 579-585.
30.	Freeman KA, Fullerton DA, Foley LS, et al. Spinal cord protection via alpha-2 agonist-mediated increase in glial cell-line-derived neurotrophic factor. J Thorac Cardiovasc Surg, 2015, 149(2): 578-584.

1. McInerney J, Ball PA. The pathophysiology of thoracic disc disease. Neurosurg Focus, 2000, 9(4): e1. doi: 10.3171/foc.2000.9.4.2.
2. Arce CA, Dohrmann GJ. Thoracic disc herniation. Improved diagnosis with computed tomographic scanning and a review of the literature. Surg Neurol, 1985, 23(4): 356-361.
3. Stillerman CB, Chen TC, Couldwell WT, et al. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg, 1998, 88(4): 623-633.
4. Currier BL, Eismont FJ, Green BA. Transthoracic disc excision and fusion for herniated thoracic discs. Spine (Phila Pa 1976), 1994, 19(3): 323-328.
5. Belanger TA, Roh JS, Hanks SE, et al. Ossification of the posterior longitudinal ligament. Results of anterior cervical decompression and arthrodesis in sixty-one North American patients. J Bone Joint Surg (Am), 2005, 87(3): 610-615.
6. Koda M, Furuya T, Okawa A, et al. Mid- to long-term outcomes of posterior decompression with instrumented fusion for thoracic ossification of the posterior longitudinal ligament. J Clin Neurosci, 2016, 27: 87-90.
7. Tang R, Shu J, Li H, et al. Surgical technique modification of circumferential decompression for thoracic spinal stenosis and clinical outcome. Br J Neurosurg, 2023, 37(3): 503-506.
8. Kong W, Ao J, Cao G, et al. Local spinal cord decompression through a full endoscopic percutaneous transcorporeal approach for cervicothoracic ossification of the posterior longitudinal ligament at the T₁-T₂ level. World Neurosurg, 2018, 112: 287-293.
9. Takahata M, Ito M, Abumi K, et al. Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine (Phila Pa 1976), 2008, 33(11): 1199-1208.
10. Yamazaki M, Mochizuki M, Ikeda Y, et al. Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion. Spine (Phila Pa 1976), 2006, 31(13): 1452-1460.
11. Yu KX, Chu L, Chen L, et al. A novel posterior trench approach involving percutaneous endoscopic cervical discectomy for central cervical intervertebral disc herniation. Clin Spine Surg, 2019, 32(1): 10-17.
12. Liao C, Ren Q, Chu L, et al. Modified posterior percutaneous endoscopic cervical discectomy for lateral cervical disc herniation: the vertical anchoring technique. Eur Spine J, 2018, 27(6): 1460-1468.
13. Chu L, Yang JS, Yu KX, et al. Percutaneous endoscopic retrieval of intraspinal cement leakage: Technical note. World Neurosurg, 2018, 118: 150-155.
14. Abiola R, Rubery P, Mesfin A. Ossification of the posterior longitudinal ligament: Etiology, diagnosis, and outcomes of nonoperative and operative management. Global Spine J, 2016, 6(2): 195-204.
15. Awwad EE, Martin DS, Smith KR, et al. Asymptomatic versus symptomatic herniated thoracic discs: their frequency and characteristics as detected by computed tomography after myelography. Neurosurgery, 1991, 28(2): 180-186.
16. Faciszewski T, Winter RB, Lonstein JE, et al. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine (Phila Pa 1976), 1995, 20(14): 1592-1599.
17. 王凯, 刘晓光, 祝斌, 等. “涵洞塌陷法”360° 胸脊髓环形减压术后短暂脊髓功能损伤加重的相关危险因素分析及预后. 中国矫形外科杂志, 2014, 22(22): 2028-2033.
18. Ahn Y. Current techniques of endoscopic decompression in spine surgery. Ann Transl Med, 2019, 7(Suppl 5): S169. doi: 10.21037/atm.2019.07.98.
19. Rosenthal D. Endoscopic approaches to the thoracic spine. Eur Spine J, 2000, 9 Suppl 1(Suppl 1): S8-S16.
20. Deng ZL, Chu L, Chen L, et al. Anterior transcorporeal approach of percutaneous endoscopic cervical discectomy for disc herniation at the C₄-C₅ levels: a technical note. Spine J, 2016, 16(5): 659-666.
21. Liu C, Liu K, Chu L, et al. Posterior percutaneous endoscopic cervical discectomy through lamina-hole approach for cervical intervertebral disc herniation. Int J Neurosci, 2019, 129(7): 627-634.
22. Li ZZ, Hou SX, Shang WL, et al. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up. Clin Neurol Neurosurg, 2016, 143: 90-94.
23. Choi KY, Eun SS, Lee SH, et al. Percutaneous endoscopic thoracic discectomy; transforaminal approach. Minim Invasive Neurosurg, 2010, 53(1): 25-28.
24. Wagner R, Telfeian AE, Iprenburg M, et al. Transforaminal endoscopic solution to a kyphoplasty complication: Technical note. World Neurosurg, 2016, 91: 195-198.
25. Wagner R, Telfeian AE, Iprenburg M, et al. Transforaminal endoscopic foraminoplasty and discectomy for the treatment of a thoracic disc herniation. World Neurosurg, 2016, 90: 194-198.
26. Ruetten S, Hahn P, Oezdemir S, et al. Full-endoscopic uniportal decompression in disc herniations and stenosis of the thoracic spine using the interlaminar, extraforaminal, or transthoracic retropleural approach. J Neurosurg Spine, 2018, 29(2): 157-168.
27. Ruetten S, Hahn P, Oezdemir S, et al. Operation of soft or calcified thoracic disc herniations in the full-endoscopic uniportal extraforaminal technique. Pain Physician, 2018, 21(4): E331-E340.
28. Yu Q, Shi L, Xu Z, et al. Therapeutic effectiveness of percutaneous endoscopic spinal surgery for intraspinal cement leakage following percutaneous vertebroplasty: An early clinical study of 12 cases. Pain Physician, 2020, 23(4): E377-E388.
29. 于庆帅, 邓瑞, 石磊, 等. 后路经皮脊柱内镜垂直锚定联合战壕技术治疗单节段中央型颈椎间盘突出症. 中国修复重建外科杂志, 2021, 35(5): 579-585.
30. Freeman KA, Fullerton DA, Foley LS, et al. Spinal cord protection via alpha-2 agonist-mediated increase in glial cell-line-derived neurotrophic factor. J Thorac Cardiovasc Surg, 2015, 149(2): 578-584.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesClinical study of percutaneous endoscopic thoracic spine surgery via trench technique for thoracic spinal cord ventral decompression

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