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이상호,임상락,이호연,전상협,한영미,정병주,Lee, Sang Ho,Lim, Sang Rak,Lee, Ho Yeon,Jeon, Sang Hyeop,Han, Young Mi,Jung, Byung Joo 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.12
Objectives : Among the various types of minimally invasive spine surgeries, thoracoscopic surgery is becoming more widely accepted and increasingly utilized. This report delineates our clinical experience using thoracoscopy to resect herniated thoracic discs in 16 patients who suffered from myelopathy or intolerable radiculopathy. Patients and Methods : Between Mar. 1997 and Sep. 1999, 16 consecutive patients underwent thoracoscopic discectomy for treatment of herniated thoracic discs. There were 12 men and 4 women(mean age 43.5 years ; range 18-61 years). Eleven patients presented with myelopathic signs and symptoms from spinal cord compression and 5 patients had incapacitating thoracic radicular pain without myelopathy. The surgical level was varied between T3 and T12. The pathology of specimen were 11 hard discs and 5 soft discs herniations. Thoracoscopic techniques were performed with long narrow spine instruments and high speed drill through 3 or 4 ports under one lung ventilated general anesthesia. During the operation three patients were converted to open thoracotomy due to intolerable one lung ventilation, excessive bleeding and inadequate operation field. The mean operation time was 264min.(range : 100-420min.), and postoperative mean admission period was 11 days. Results : Clinical and neurological outcomes were good in all patients(mean follow-up period 20 months). Among the eleven myelopathic patients, 8 improved neurologically, and 3 stabilized. Among the five radiculopathic patients, 4 recovered completely and no patient had worsened. Postoperative complications were pleural effusion in one case, intercostal neuralgia in one, delayed hemopneumothorax in one, prolonged air leakage in one and pneumonia in one case. Conclusions : Thoracoscopic discectomy needs a steep learning curve to be familiar to anatomical space and handling of endoscopic instruments. However, it is technically feasible and can be effectively performed with acceptable results.
내시경을 이용한 경흉강 늑막외측 접근 흉추 추간판 절제술 3례 - 수술수기 증례보고 -
이상호,전상협,최종렬,이호연,정병주,임상락,Lee, Sang-Ho,Jeon, Sang-Hyeop,Choi, Jong-Yeul,Lee, Ho-Yeon,Jung, Byung-Joo,Lim, Sang-Rak 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.12
Microsurgical transthoracic extrapleural approach for thoracic discectomy in three cases were modified and simplified in order to achieve better exposure of ventral extradural space than posterolateral extrapleural(lateral extracavitary) approach and less pulmonary complications than transthoracic transpleural approach. These approaches were optimized by microscope and video-assistance. Surgery was followed by clinical improvement in all patients. The results of treatment seem to support the use of these modified techniques as adequate surgical treatment of thoracic disc herniations without any complications.