Document Type : Research articles


1 Department of Orthopedics, Affiliated Hospital of Nantong University, Jiangsu, China

2 Department of pain, Affiliated Hospital of Nantong University, Jiangsu, China


Background: The importance of lateral transforaminal endoscopic treatment of thoracic disc herniation lies in the fact that the use of a needle can remove some of the disc contents and cause the disc herniation to disappear. The present study aimed to evaluate the effect of percutaneous endoscopy on the treatment of patients with thoracic disc herniation.Objectives: To investigate the clinical efficacy and feasibility of transforaminal endoscopic discectomy in the treatment of thoracic disc herniationMethods: This retrospective analysis was conducted on patients with thoracic hernias between January 2014 and December 2019. A total of 13 operative cases were selected via census sampling. Lateral endoscopic treatment of thoracic disc herniation was performed on patients, and they were followed up for 6-18 months. All patients were assessed by the visual analog scale Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) before the surgery, as well as one week, three months, and six months after the operation, respectively.Results: The sample included 13 patients with a mean age of 60.3 years. The location of the thoracic disc herniation varied among the patients. The VAS scores before the surgery, as well as one week, three months, and six months after the surgery, were 7±0.8, 3.3±0.6, 2.3±0.8, 1.4±0.3, and 1.3±0.4, respectively, pointing to a significant decrease (P?0.001). The ODI scores before the surgery, one day after surgery, one week after surgery, three months after surgery, and six months after surgery were 65.2±5.8%, 11.5±5.3%, 8.9±3.3%, 5.3±2.5, and 4.7±3.5, demonstrating a significant decrease (P?0.001). The score of the Macnab standard, a rating system evaluating the effectiveness of spine surgeries, was also satisfactory.Conclusion: As evidenced by the results of this study, percutaneous endoscopy in the treatment of patients with thoracic disc herniation was able to improve the clinical condition of patients and replace the previous methods of thoracic hernia surgery as an effective, efficient, and safe method.


  1. Oppenlander ME, Clark JC, Kalyvas J, Dickman CA. Surgical management and clinical outcomes of multiple-level symptomatic herniated thoracic discs. J Neurosurg Spine. 2013;19(6):774-83. doi: 10.3171/2013.8.SPINE121041. [PubMed: 24116677].
  2. Jiang X, Zhou X, Xu N. Clinical effects of transforaminal and interlaminar percutaneous endoscopic discectomy for lumbar disc herniation: A retrospective study. Medicine (Baltimore). 2018;97(48):e13417. doi: 10.1097/MD.0000000000013417. [PubMed: 30508947].
  3. Lee SH, Musharbash FN. Uniportal, Transforaminal endoscopic thoracic discectomy: review and technical note. Neurospine. 2023;20(1):19-27. doi: 10.14245/ns.2346074.037. [PubMed: 37016850].
  4. Bae J. Transforaminal endoscopic thoracic discectomy and decompression. Core Techniques of Minimally Invasive Spine Surgery. Springer; 2023. p. 111-8.
  5. Amato MCM, Aprile BC, Esteves LA, Carneiro VM, de Oliveira RS. Full endoscopic thoracic discectomy: is the interlaminar approach an alternative to the transforaminal approach? A technical note. Int J Spine Surg. 2022;16(2):309-17. doi: 10.14444/8209. [PubMed: 35444040].
  6. Bouthors C, Benzakour A, Court C. Surgical treatment of thoracic disc herniation: an overview. Int Orthop. 2019;43:807-16. doi: 10.1007/s00264-018-4224-0. [PubMed: 30406842].
  7. Kim M, Kim HS, Oh SW, Adsul NM, Singh R, Kashlan ON, et al. Evolution of spinal endoscopic surgery. Neurospine. 2019;16(1):6-14. doi: 10.14245/ns.1836322.161. [PubMed: 31618807].
  8. Khandge AV, Sharma SB, Kim JS. The evolution of transforaminal endoscopic spine surgery. World Neurosurg. 2021;145:643-56. doi: 10.1016/j.wneu.2020.08.096. [PubMed: 32822954].
  9. Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Huang B. Disc herniation in the thoracolumbar junction treated by minimally invasive transforaminal interbody fusion surgery. J Clin Neurosci. 2014;21(3):431-5. doi: 10.1016/j.jocn.2013.04.029. [PubMed: 24225365].
  10. Liu Y, XU B, JI N, Jiang H, Yang Q. Preliminary experience of percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. Tianjin Med J. 2017:121-4.
  11. Yates M, Shastri-Hurst N. The oswestry disability index. Occup Med. 2017;67:241-2. doi: 10.1093/occmed/kqw051.
  12. Özger Ö, Kaplan N. Evaluation of clinical outcomes of 271 patients undergoing lumbar microdiscectomy in the light of literature. Ann Med Res. 2020;27:664-9. doi: 10.5455/annalsmedres.2019.11.739.
  13. Bae J, Chachan S, Shin SH, Lee SH. Transforaminal endoscopic thoracic discectomy with foraminoplasty for the treatment of thoracic disc herniation. J Spine Surg. 2020;6(2):397-404. doi: 10.21037/jss.2019.11.19. [PubMed: 32656377].
  14. Meng S, Han J, Xu D, Wang Y, Han S, Zhu K, et al. Fully endoscopic transforaminal discectomy for thoracolumbar junction disc herniation with or without calcification under general anesthesia: Technical notes and preliminary outcomes. Front Surg. 2023;9:1067775. doi:
  15. 3389/fsurg.2022.1067775. [PubMed: 36684323].
  16. Choi G, Munoz-Suarez D. Transforaminal endoscopic thoracic discectomy: technical review to prevent complications. Neurospine. 2020;17(1):58–65. doi: 10.14245/ns.2040250.125. [PubMed: 32746518].
  17. Houra K, Saftic R, Knight M. Five-Year outcomes after transforaminal endoscopic foraminotomy and discectomy for soft and calcified thoracic disc herniations. Int J Spine Surg. 2021;15(3):494-503. doi: 10.14444/8071. [PubMed: 33963033].
  18. Cao Z, Li ZZ, Zhao HL, Zhu JL, Hou SX. Technical notes and clinical outcomes of full-endoscopic interbody fusion via transforaminal approach for hard disc herniations in thoracolumbar junction. Orthop Surg. 2023;15(7):1893-903. doi: 10.1111/os.13759. [PubMed: 37259903].
  19. Iwasaki M, Akino M, Hida K, Yano S, Aoyama T, Saito H, et al. Clinical and radiographic characteristics of upper lumbar disc herniation: ten-year microsurgical experience. Neurol Med Chir (Tokyo). 2011;51(6):423-6. doi: 10.2176/nmc.51.423. [PubMed: 21701105].
  20. Lubelski D, Abdullah KG, Steinmetz MP, Masters F, Benzel EC, Mroz TE, et al. Lateral extracavitary, costotransversectomy, and transthoracic thoracotomy approaches to the thoracic spine: review of techniques and complications. J Spinal Disord Tech. 2013;26(4):222-32. doi: 10.1097/BSD.0b013e31823f3139.
  21. [PubMed: 22143047].
  22. Zhao Y, Wang Y, Xiao S, Zhang Y, Liu Z, Liu B. Transthoracic approach for the treatment of calcified giant herniated thoracic discs. Eur Spine J. 2013;22(11):2466-73. doi: 10.1007/s00586-013-2775-8. [PubMed: 23771552].
  23. Wait SD, Fox DJ, Jr., Kenny KJ, Dickman CA. Thoracoscopic resection of symptomatic herniated thoracic discs: clinical results in 121 patients. Spine. 2012;37(1):35-40. doi: 10.1097/BRS.0b013e3182147b68. [PubMed: 21336237].
  24. Miao X, He D, Wu T, Cheng X. Percutaneous endoscopic spine minimally invasive technique for decompression therapy of thoracic myelopathy caused by ossification of the ligamentum flavum. World Neurosurg. 2018;114:8-12. doi: 10.1016/j.wneu.2018.02.152. [PubMed: 29524712].
  25. Sharifzad F, Yasavoli‐Sharahi H, Mardpour S, Fakharian E, Nikuinejad H, Heydari Y, et al. Neuropathological and genomic characterization of glioblastoma‐induced rat model: How similar is it to humans for targeted therapy? J Cell Physiol. 2019;234(12):22493-504. doi: 10.1002/jcp.28813. [PubMed: 31120149].
  26. Qian JX. Development and future of transforaminal endoscopic spine system. Zhongguo Gu Shang. 2018;31(4):297-301.
  27. Wang H, Huang B, Li C, Zhang Z, Wang J, Zheng W, et al. Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery. Clin Neurol Neurosurg. 2013;115(10):1987-91. doi: 10.1016/j.clineuro.2013.06.008. [PubMed: 23830496].