Endoscopic thoracic discectomy

In one minute

Endoscopic thoracic discectomy removes a thoracic disc herniation (a disc bulge in the mid-back, between the neck and the waist) through a keyhole at the side of the back, outside the chest. Our incision is 7 mm; the published series work through a cannula or incision of about 7.5 to 8 mm. It is for the rare patient whose band-like chest or belly pain, leg symptoms or early spinal cord signs come from a soft herniation to one side that has not settled. The operation averaged about 80 minutes per level in the endoscopic series pooled by a 2026 review, mostly under local anaesthesia with sedation. Most of our patients walk the same day and go home within 24 hours.

What the operation is

The literature calls it full-endoscopic thoracic discectomy, transforaminal endoscopic thoracic discectomy (TETD) or percutaneous endoscopic thoracic discectomy; "transforaminal" means the route runs through the foramen, the opening beside the spine where the nerve leaves. Ruetten and colleagues describe three full-endoscopic routes: interlaminar, extraforaminal and transthoracic retropleural.

The surgeon removes the herniated fragment and, where the opening is tight, shaves a little bone to widen it (foraminoplasty). Nothing is implanted. Open thoracic discectomy reaches the disc by opening the chest (thoracotomy) or removing part of a rib (costotransversectomy), and often adds screws: in a 2026 review, 94.1% of open cases had a fusion against 1.4% of endoscopic ones.

Who it is for

Symptomatic thoracic herniation is uncommon: less than 1% of all disc herniations, and 30 to 70% of them are calcified. Yet a thoracic herniation on MRI (magnetic resonance imaging) is common in people with no symptoms: in a study of 90 people without thoracic symptoms, 37% had a herniation and 29% some deformation of the cord. So the first question is whether the herniation explains the symptoms; most do not need an operation.

The endoscope suits a soft herniation lying to the side or just off centre, causing radiculopathy (pain or numbness along a rib) or early myelopathy (spinal cord dysfunction), after conservative care has failed or when cord signs are progressing. A 92-patient series was limited to soft, paramedian-to-lateral herniations and lists calcified or sequestered discs as contraindications; newer series push those limits, and in the 2026 review 29.8% of endoscopic cases were calcified or partly calcified. Large central calcified discs adherent to the dura remain the territory of open surgery, and instability calls for fusion.

How it is done

You lie face down. In the meta-analysis of 285 patients, 77.9% were operated under local anaesthesia with sedation, which lets you report any sensation while the surgeon works near the cord; general anaesthesia is used when the surgeon or anaesthetist prefers it.

An X-ray plots the path from the side of the back, above the rib and outside the lung. Dilators open a corridor for the working tube, which docks at the foramen: the 92-patient series used a 7.5 mm working cannula and the illustrative case in the 2026 review an 8 mm incision; our incision is 7 mm. A reamer or fine burr shaves the facet to widen the opening, the endoscope goes in with saline irrigation for a clear view, and the fragment is removed piece by piece while the dura and root are watched on the screen. The surgeon confirms the pressure is off, withdraws the tube and closes with one stitch.

Endoscopic compared with open surgery

There is no randomised trial and the series are small, so the comparison rests on reviews. The 2026 systematic review pooled 23 studies and 695 patients, 586 endoscopic and 109 open. Endoscopic surgery had a shorter operation (82 versus 201 minutes per level), less blood loss (19 versus 355 mL), far fewer fusions (1.4% versus 94.1%) and a shorter stay (2.65 versus 10.5 days), with comparable reoperation (3.7% versus 5.5%) and recurrence (2.2% versus 0%) and similar pain and function. Its authors grade the included studies as small, retrospective, single-centre series.

A 2019 network meta-analysis of 15 studies and 1,036 operations found overall morbidity as high as 29%: medical complications 21%, surgical-site 11%, spinal-fluid-related 8% and neurological 5%, with three deaths, and higher risk for anterior and lateral than for posterolateral approaches.

Risks and how we reduce them

The 2023 single-arm meta-analysis of 13 endoscopic series gives the ranges: dural tear 1.3% (95% confidence interval 0 to 2.6%), dysesthesia (an unpleasant altered sensation along the nerve) 4.7% (2.0 to 7.3%), recurrent herniation 2.9% (0.6 to 5.2%), new or worsened myelopathy 2.1% (0.4 to 3.8%), epidural haematoma 1.1% (0.2 to 2.5%) and reoperation 1.7% (0.1 to 3.4%), with no infection or death reported. In the 92-patient series, one patient (1.1%) had transient weakness, three (3.3%) transient leg tingling and two (2.2%) a symptomatic recurrence. Incomplete removal of a hard fragment, conversion to open surgery and injury to the nearby lung are the other risks.

How the risks are reduced: the published series plan the route on a CT (computed tomography) scan read with the MRI, because calcification decides the approach, and the 92-patient series excluded calcified and sequestered discs from the transforaminal endoscopic operation. Local anaesthesia with sedation, used in 78% of pooled cases, lets the patient report sensation while the surgeon works near the cord. Central, calcified, giant discs remain the territory of open surgery in the 2024 meta-analysis. Most of our endoscopic decompressions are done under local anaesthesia with sedation, the anaesthetist and surgeon deciding per patient. Across all the team's operations our complication figure is well below 1%; our own figure, not a comparison.

Recovery, week by week

What the evidence says

The 2023 European Spine Journal meta-analysis of 285 endoscopic patients reports low pooled complication rates and calls for controlled studies.

The 2026 Journal of Spine Surgery review of 695 patients finds endoscopic surgery faster, with fewer fusions and shorter stays than open surgery in selected patients, on retrospective level III and IV evidence.

Bae and colleagues (2020) report 92 consecutive transforaminal endoscopic thoracic discectomies under local anaesthesia with sedation, 90% excellent or good, in carefully selected soft herniations.

Ruetten and colleagues (2018) report 55 full-endoscopic thoracic decompressions by three approaches with one revision for bleeding and one persistent worsening of myelopathy.

The 2019 network meta-analysis and the 2024 meta-analysis document the morbidity of open approaches and favour posterolateral over anterior routes, while noting that anterior surgery may still be needed for central calcified herniations.

How we do it at spine.uz

We are Tashkent's first endoscopic spine team, five surgeons operating as one, with 27,600+ endoscopic and spine operations, and we treat the full range of surgical spine pathology. This page was reviewed by Dr. Akhror Yakubov, neurosurgeon. The endoscopic discectomy uses a 7 mm incision and no implants; most patients walk on the day of surgery and go home within 24 hours; most endoscopic decompressions are done under local anaesthesia with sedation, the anaesthetist and surgeon deciding per patient.

Send your MRI on Telegram or WhatsApp; a doctor from the team replies by voice within 48 hours, free of charge. After surgery you receive a written conclusion and follow-up on Telegram.

Preparing for the operation

Send every slice of the thoracic MRI and any CT ahead; the CT shows calcification. Bring your medicines list and tell the surgeon about blood thinners so they can be paused safely. Fast from the night before, arrange someone to accompany you, and expect to be walking the same day.