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Three-Dimensional Printing for Percutaneous Endoscopic Thoracic Discectomy in Thoracic Disc Herniations: Case Report and Anatomy Review

Abstract

Zhou Chuanli, Anthony Yeung, Huang Hui, Zhang Guoqing, Gu Tong-Tong, Ma Xuexiao and Chen Xiao-Liang

Introduction: Thoracic disc herniations causing unrelenting neuralgia are relatively rare, especially cephalad to T-10 because the rib cage provides enough stability to offer relief with non-surgical methods over time. A transforaminal percutaneous endoscopic thoracic approach (PETD) however, is a feasible minimally invasive option for decompressing and removing the herniation without resorting to a more invasive and surgically more morbid open approach requiring thoracotomy and removal of the rib head through the thoracic cavity.

Method: The application of three-dimensional printing of individualized anatomic models, improves the accuracy and safety of this less invasive percutaneous operation that allows for surgical performance under local anesthesia. With the data provided by preoperative three-dimensional reconstructive CT scans, an individualized 3-D thoracic model is established by using medical mimics’ software, produced with a 3-D laser printer. A more exact trajectory with a calculated skin entry point provides extra safety for a percutaneous postero-lateral approach.

A 16-year-old male, with a thoracic disc herniation and unrelenting neuralgia, is diagnosed by CT scans and magnetic resonance imaging. Non-surgical methods failed to help his severe intercostal neuralgia. Following a preoperative evaluation, a percutaneous decompression was performed, aided by 3-D printing of the thoracic spine. PETD was performed under local anesthesia.

Result: The patient had immediate resolution of his pre-operative radiating pain with no operative surgical morbidity. Extra safety is provided by operating with the patient awake.

Conclusion: Thoracic disc herniations can be decompressed safely and effectively under local anesthesia by percutaneous endoscopic thoracic decompression (PETD). 3 D printing reconstructing the individual’s anatomy at the herniation level provides an additional method for trajectory guidance. Accuracy in a trans-foraminal approach for thoracic disc herniations is critical because of the close proximity of the spinal cord and the chest cavity.