Posterior Thoracic Microdiscectomy

Posterior thoracic microdiscectomy via the transfacet pedicle-sparing and transpedicular approaches provides safe and minimally invasive access to disc herniations within the thoracic spine. These approaches have been developed to treat both radiculopathy and myelopathy in a manner that allows complication avoidance and relief of symptoms. The minimally invasive nature of the procedure allows access to a noncalcified herniated disc without traversing the thoracic cavity and reduction in soft tissue disruption. Intraoperative anatomic landmarks are critical to successful discectomy, and these are discussed in terms of both visual and radiographic appearances. Cerebrospinal fluid leak, spinal cord injury, and pneumothorax are known complications of this procedure; however, maneuvers for avoidance as well as treatment are provided. Outcomes from posterior thoracic microdiscectomy have improved dramatically in recent years with improvements in imaging, instrumentation, and techniques. Mastery of the skills and tools described within this chapter will allow surgeons to manage thoracic disc herniations via a minimally invasive approach.