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Review
. 2021 Jan 4;6(1):50-60.
doi: 10.1302/2058-5241.6.200080. eCollection 2021 Jan.

Full endoscopic surgery for thoracic pathology: an assessment of supportive evidence

Rory D S Gibson  1 , Ralf Wagner  2 , J N Alastair Gibson  3
Affiliations
Review

Full endoscopic surgery for thoracic pathology: an assessment of supportive evidence

Rory D S Gibson et al. EFORT Open Rev. .

Abstract

In the last five years, surgeons have applied endoscopic transforaminal surgical techniques mastered in the lumbar spine to the treatment of thoracic pathology.The aim of this systematic review was to collate the available literature to determine the place and efficacy of full endoscopic approaches used in the treatment of thoracic disc prolapse and stenosis.An electronic literature search of PubMed, Embase, the Cochrane database and Google Scholar was performed as suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis statements. Included were any full-text articles referring to full endoscopic thoracic surgical procedures in any language.We identified 17 patient series, one cohort study and 13 case reports with single or of up to three patients.Although the majority included disc pathology, 11 papers related cord compression in a proportion of cases to ossification of the ligamentum flavum or posterior longitudinal ligament. Two studies described the treatment of discitis and one reported the use of endoscopy for tumour resection.Where reported, excellent or good outcomes were achieved for full endoscopic procedures in a mean of 81% of patients (range 46-100%) with a complication rate of 8% (range 0-15%), comparing favourably with rates reported after open discectomy (anterior, posterolateral and thoracoscopic) or by endoscopic tubular assisted approaches. Twenty-one of the 31 author groups reported use of local anaesthesia plus sedation rather than general anaesthesia, providing 'self-neuromonitoring' by allowing patients to respond to cord and/or nerve stimuli. Cite this article: EFORT Open Rev 2021;6:50-60. DOI: 10.1302/2058-5241.6.200080.

Keywords: full endoscopic; thoracic discectomy; transforaminal surgery.

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Conflict of interest statement

ICMJE Conflict of interest statement: RDSG declares no conflict of interest relevant to this work. RW reports consultancy for joimax GmbH and a webinar series for joimax GmbH outside the submitted work. JNAG reports consultancy for joimax GmbH, a patent for an endoscopic retractor for joimax GmbH and a webinar series for joimax GmbH, all outside the submitted work.

Figures

Fig. 1
Fig. 1
Thoracic endoscope (joimax®, GmbH).
Fig. 2
Fig. 2
Surgical approaches to the thoracic spine.
Fig. 3
Fig. 3
Endoscopic access via the Kambin triangle.
Fig. 4
Fig. 4
Enlargement of foramen.
Fig. 5
Fig. 5
Areas of endoscopic decompression.
Fig. 6
Fig. 6
Interlaminar unilateral laminotomy for bilateral decompression.
Fig. 7
Fig. 7
PRISMA flow diagram outlining article selection.
See this image and copyright information in PMC

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