Name: Endoscopic Transforaminal Thoracic Discectomy and Ventral Dural Access: Case Presentation of a 40-Year-Old Patient
Uploaded: 2026-07-15T00:00:00Z
Channel: Arthrex
Description: Corey T. Walker, MD (Los Angeles, CA), presents a thoracic spine case demonstrating an endoscopic transforaminal approach for treating a spontaneous ventral dural cerebrospinal fluid (CSF) leak. This case provides an opportunity to highlight the advantages of endoscopic techniques in the thoracic spine, including improved access to ventral pathology and reduced surgical morbidity.

Karriere

Human

_blank

Unternehmen

Über uns

Community Events

Globale Offenlegung der Lieferkette

Standorte

Förderung

Produktsicherheit 

Risikomanagement & Compliance

Virtual Patent Marking

Newsroom

SBA Support

Veranstaltungen, Lab-Vorführungen und Schulungsmöglichkeiten ansehen

Medizinproduktberater:in kontaktieren

Unseren Newsletter abonnieren

Medical Education

Kursbeschreibungen

Schulungen & Lehrgänge

ArthroLab™-Standorte

Unser klinisches Personal stellt sich vor

OrthoPedia

Datenschutz

Rechtliche Hinweise

Ethics Helpline

Hilfe

Cookie Settings

Allgemeine Informationen

ACLTear.com

AnkleSprain.com

BunionPain.com

ArthrexEndoscopicSpine.com

JointPreservation.com

KneeReplacementProcedure.com

OrthoPedia Patient

ShoulderReplacement.com

TheNanoExperience.com

Shoulder

Procedure

Stetige Produktinnovationen und neue Techniken erleichtern die Behandlung zahlreicher Indikationen im Schulterbereich.

Schulter

Team Home Templated (A)

Knee

Stetige Produktinnovationen und neue Techniken erleichtern die Behandlung zahlreicher Indikationen im Kniebereich.

Knie

Elbow

Stetige Produktinnovationen und neue Techniken erleichtern die Behandlung zahlreicher Indikationen im Ellenbogenbereich.

Ellenbogen

Arthroplasty Shoulder

Schulterendoprothetik

Hand and Wrist

Stetige Produktinnovationen und neue Techniken erleichtern die Behandlung zahlreicher Indikationen im Bereich Hand und Handgelenk.

Hand und Handgelenk

Foot and Ankle

Stetige Produktinnovationen und neue Techniken erleichtern die Behandlung zahlreicher Indikationen im Bereich Fuß- und Sprunggelenk.

Fuß und Sprunggelenk

Trauma Lower Extremities

Trauma Upper Extremities

Trauma

Stetige Produktinnovationen und neue Techniken erleichtern die Behandlung zahlreicher Indikationen im Hüftbereich.

Hüfte

Orthobiologics

Stetige Produktinnovationen und neue Techniken erleichtern die Behandlung zahlreicher Indikationen im Bereich Orthobiologie.

Orthobiologie

Cardiothoracic Surgery

Spine

Wirbelsäule

Product

Herz-Thoraxchirurgie

Imaging and Resection

Stetige Produktinnovationen und neue Techniken im Bereich Bildgebung und Resektion für die orthopädische und Allgemeinchirurgie.

Bildgebung & Resektion

Kodierungs-Hotline

eDFUs (Instructions for Use)

Global Enterprise Labeling System (GELS)

Unique Device Identifier (UDI)

Exhibit-Congress & Workshop Requests

Rep Site

The Arthrex Surgeon App

Facebook

Instagram

LinkedIn

Youtube

Corey T. Walker, MD (Los Angeles, CA), presents a thoracic spine case demonstrating an endoscopic transforaminal approach for treating a spontaneous ventral dural cerebrospinal fluid (CSF) leak. This case provides an opportunity to highlight the advantages of endoscopic techniques in the thoracic spine, including improved access to ventral pathology and reduced surgical morbidity.

Not Hidden

English  - en

video

VID1-009593-en-US | A | Endoscopic Transforaminal Thoracic Discectomy and Ventral Dural Access: Case Presentation of a 40-Year-Old Patient

Corey T. Walker, MD

Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

Videos von Fallpräsentationen

Case Presentation Videos

Cirurgiões que apresentam um ou mais casos clínicos.

Vídeos apresentações de casos

Cirujanos que presentan uno o más casos clínicos.

Video presentaciones de casos

Endoscopic Transforaminal Thoracic Discectomy and Ventral Dural Access: Case Presentation of a 40-Year-Old Patient

Speaker  Hi, I'm Corey Walker, I'm a neurosurgeon from Cedars-Sinai in Los Angeles. I'm going to be talking to you today about endoscopic transforaminal thoracic approaches to treat thoracic pathologies. Many of the pathologies in the thoracic spinal cord occur. Ventral to the spinal cord. Accessing these can be difficult. Retraction of the spinal cord raises the risk of spinal cord injury. Traditional posterior approaches have been performed to try to access ventral pathologies, but occur and may fail to allow direct visualization of that pathology. Many of the most common pathologies of the thoracic spine do occur on the ventral side of the spinal cord. These include thoracic disc, herniations tumors, fractures, infections, and even spontaneous cerebrospinal fluid leaks. The most common posterior approaches include the posterolateral transpedicular, costotransversectomy and lateral extracavitary approaches. These are limited by the requirement of extensive muscle dissection, the concomitant need for multilevel fixation and fusion, and often poor visualization of the ventral dura. The anterior and lateral approaches allow for more direct visualization of the ventral dura. However, traditional transthoracic approaches require deflation of the lung and risk of lung complications, and mini open lateral retropleural approach can also be considered. However, there are associated risks with this as well, including pneumothorax, hemothorax and CSF venous fistula. The benefits of endoscopy are gained through the access of visualization with a 30 degree scope using an oblique trajectory going through the foramen. You can see the ventral dura and seeing across the ventral spinal canal. Speaker  This allows for you to see that without requiring spinal fusion. Additionally, there is less muscle dissection, reduced pain, less blood loss and overall reduced complications for patients. Thoracic endoscopic transforaminal approaches are complex. These are typically not for the novice endoscopic spine surgeon. Surgeons should attempt to treat a number of lumbar cases first on more simple pathologies, to get acquainted with the technology and the approach before attempting to treat thoracic pathologies. Typically, lower thoracic levels tend to be better approached. This is because the scapula in the upper thoracic levels above T6 can limit access. Additionally, the foramen tend to be taller at the lower thoracic levels. At the upper thoracic levels, the interpedicular distance can be limiting and make the access more challenging. Before performing a transforaminal thoracic endoscopic approach, you have to carefully study the anatomy. Often, there is a better side to approach from. Additionally, there are unique anatomical limitations not seen in lumbar transforaminal approaches that make this more complex. The first thing you have to ensure that you avoid in these approaches is entering the thoracic cavity. Obviously, you don't want to get into the thoracic cavity and cause some sort of lung complication. The thoracic spine is abutted by the rib heads. It's. These come up to the lateral foramen and the pedicle and can limit access. Speaker  Additionally, in the thoracic spine, the transverse processes extend cranially and can make accessing slightly more difficult, while a number of pathologies occur in the thoracic spine. We present a case here showing access to the ventral dura for a spontaneous CSF leak. One of my partners, who is an international expert in CSF leaks, was referred to this patient who had low pressure headaches. She was found on digital subtraction myelography to have a leak. As you can see here in the imaging, the dye that goes into the thecal sac is exiting at the T eight nine level. The fluid that is going into the spinal canal is exiting into the ventral epidural space. The CT myelogram shown here shows a very small thoracic disc herniation. This is the site of the leak and is the point at which we need to access. As you can see, it's not a large compressive disc as we typically would see for most thoracic disc herniations. The traditional approach here would be to do an open laminectomy with a transdural closure. This involves opening the thecal sac, retracting the spinal cord, and placing a muscle plug in this traditional approach. This would cause damage to the posterior elements, the Ligamentous complex, and cause more pain and muscle disruption. As you can see here, there is extensive pertinent anatomy to the thoracic spine. The bony challenges here are what make accessing the transforaminal approach in the endoscopic spine more difficult. Speaker  The rib head abutting the thoracic spine needs to be removed. This rib head can get in the way from getting to the lateral pedicle. Additionally, we need to remove part of the superior aspect of the inferior pedicle. This will allow expansion of the foramen, increasing the space between the exiting nerve root and the top of the pedicle, so the cannula can get into the disc space more easily, and to see pathologies above and below the level of the disc space. Additionally, you need to remove part of the lateral superior articulating process and facet complex. This will allow you to see the lateral dura, as the foramen is slightly smaller in the thoracic spine compared to the lumbar spine. You want to avoid taking too much facet in order to destabilize the patient. Removing part of the pedicle and a part of the facet complex does not destabilize the patient. After this is performed, you can start to see the lateral thecal sac. Potentially, you may need to remove part of the vertebral body and do a partial corpectomy and allow yourself to gain access. This is more common for things like thoracic calcified disc herniations. However, not all pathologies require this. Here you can see the fluoroscopic docking of the jamshidi needle at the level of the disc space. In these cases, we use Neuromonitoring. Speaker  Specifically, we use somatosensory evoked potentials and motor evoked potentials to carefully monitor the integrity of the spinal cord. As we place the jamshidi needle. We're always careful not to go medial to the medial particular line. We enter slightly cranial to caudal to avoid hitting inferior transverse process. As we carefully dilate. I continue to take AP fluoroscopic images to make sure that we're in the right place. We want to ensure that we're below the exiting nerve root. Reamers can be used to debride the bone of the lateral facet and gain access for the cannula. Care should be taken, not to advance the reamers too far. Dilation here should be performed carefully. As you dilate over the QR into the transforaminal space, you want to avoid injuring the exiting nerve root. Reamers can be considered to debride and expand. This space should be done carefully to avoid injuring that exiting nerve root and advancing them too deep. In this video, you can see us removing the superior aspect of the inferior pedicle and the superior articulating process as it comes up over the lateral facet complex. The rib head has already been removed. We carefully dissect away the tissue over the lateral spinal cord. This allows us to see the thecal sac and the ventral disc complex. In this case, there is a small disc herniation. This is noted to be stuck to the ventral dura and is the site of the spinal fluid leak. Speaker  As we dissect this away, you can see the small ventral dural hole. This is the site where CSF is egressing and exiting the spinal canal. We carefully shrink down the disc and close off the spinal fluid leak. This is performed with a fibrin sealant packed into the dural defect. We ensure that there is appropriate closure of the dural defect. Once this is done sufficiently, we know that there is no more spinal fluid leaking. At the end of the case, we will pack the space with fibrin glue and close. Post-operatively. The patient did very well. She was able to go home the next day after completion of her post-operative imaging studies. She had minimal incisional pain and required no narcotics and importantly, she had resolution of her low pressure headaches. As discussed, there are many shortcomings that can come with doing this approach. This is not an easy procedure, and there are several pitfalls that you may encounter. The foramen are slightly smaller than in the lumbar spine. Care needs to be made to ensure that there is no damage or injury to the exiting nerve root. Therefore, careful studying of the preoperative MRI is important. This will ensure that you have an appropriate amount of space between the exiting nerve root and the top of the pedicle. Speaker  Additionally, in the thoracic spine cases, you need to create a large enough potential space. Oftentimes, you are limited in advancing your cannula to see the ventral dura. This is typically because you have not removed a significant enough amount of the rib head. Drilling more of the rib head allows you to create that space and allows you to see the ventral dura. Sometimes you also need to remove part of the lateral vertebral body to see this as well. If you find yourself getting stuck in advancing your cannula, you probably need to remove more bone. Lastly, pathology is at the mid vertebral level can be more challenging than those at the level of the disc space. This is because the exiting nerve root limits your cranial visualization. For people beginning this procedure, they may consider using a navigated jamshidi to access the transforaminal space. However, most procedures are performed safely with traditional fluoroscopy. Once the Jamshidi is in place, the k-wire should be performed under fluoroscopy to ensure that there is no entry into the spinal canal and no spinal cord injury. In conclusion, spinal endoscopy is an exciting, ultra minimally invasive way to access the ventral thoracic spine to treat various pathologies. It allows you to avoid spinal fusion, extensive muscle trauma risk to the lung and thoracic cavity, and to get direct visualization of the ventral thoracic spinal cord. Thank you.

Endoskopische thorakale transforaminale Diskektomie

Endoscopic Transforaminal Thoracic Discectomy and Ventral Dural Access: Case Presentation of a 40-Year-Old Patient

Related Pages

Spine

Endoskopische thorakale transforaminale Diskektomie

Product

Operationsverfahren

Produkt

Medical Education

Unternehmen

Ressourcen

Patient:in

Karriere