Title : Percutaneous laser microdiscectomy in the treatment of thoracic intervertebral disc protrusions: Difficulties and dangers
Abstract:
Objective: To improve the outcomes of treatment of thoracalgia caused by protrusions of the thoracic IVD, using the method of puncture laser microdiscectomy (PLM).
Materials and Methods: A retrospective analysis of treatment outcomes of 64 patients with thoracalgia at the "Endoscopic Neurosurgery" Medical Center in the period from 2000 to 2023 was carried out. The patients ranged in age from 24 to 67 years. There were 48 (75.5%) men, 16 (24.5%) women. Puncture laser microdiscectomy was performed in 42 patients under the control of a C-Arm operating fluoroscope (Philips, the Netherlands), 22 - under CT-assisted method (Toshiba, Japan).
Results: In the presence of only one affected disc, itwas easy to determine the level of PLM appropriate for the level of pain (56% of cases), whereas in the presence of detection of two or more affected discs, it was a difficult task. In such cases, lidocaine blockade (lidocaine test) of one of the spinal roots corresponding to the presumably affected disc was performed. Of the 28 patients in whom two or more affected IVDs were identified, lidocaine test blockade was applied in 14 cases. The lidocaine test provides more accurate determination of the level of damage to the IVD (which is related to the severity of pain) and contributes to a better effect of PLM. However, the difference was not statistically significant (p=0.509). In 10 cases, PLM was performed on two IVDs. Complications were reported only in 3 patients operated on under the control of a fluoroscope. In 2 of them it was caused by technical errors. Thus, in one patient, the needle penetrated the pleural cavity and damaged the lung. A needle insertion into the spinal canal was the cause of complication in two cases. No neurological symptoms were noted, but both patients developed symptoms of meningism after 24 hours. A diagnostic lumbar puncture in the cerebrospinal fluid revealed an admixture of blood as a consequence of an error during the PLM. The incidence of positive outcomes in the treatment of thoracic IVDs with PLM method was 89%.
Conclusions: Puncture laser microdiscectomy of thoracic IVD protrusions is an effective method of treating persistent thoracalgia. A lidocaine test should be performed to identify the source of pain in case of several IVD injuries. Performing PLM under CT assisted surgery does not increase the efficacy of surgery but avoids complications.
Keywords: thoracalgia; thoracic intervertebral discs; laser microdiscectomy
