Preoperative localization of herniated thoracic discs using myelo-CT guided transpleural puncture: technical note

Objective In recent years, video-assisted thoracoscopic microdiscectomy has gained acceptance as a minimally invasive, safe, and efficient technique suited for herniated thoracic discs from T4T5 until T11T12. However, correct localization is difficult and wrong level exploration is an ever-present threat. We present a reliable and time-efficient localizing technique.Materials and methods In 86 consecutive cases, 1 day preoperatively intrathecal contrast was administered and a computed tomography (CT) scan was performed in prone position. Using local anesthesia, a hollow needle was advanced above the corresponding rib and through the pleura. The inner wire and corresponding pathological level were easily identified endoscopically.Conclusion Myelo-CT provides detailed anatomical information, which is often helpful in determining the side of operative approach and the extent of bone removal needed. Needle localization obviates fluoroscopy, saves OR time, and allows the surgeon to focus on the technically demanding procedure. Furthermore, it is a relatively simple and safe technique.