经单侧双通道脊柱内镜技术治疗胸椎间盘突出症1例并文献复习

Unilateral Biportal Endoscopic Surgery for Thoracic Disc Herniation: A Case Report and Literature Review

摘要: 胸椎间盘突出症(TDH)是临床罕见的脊柱退行性疾病，手术治疗难度大、风险高，传统开放手术创伤显著，现有微创技术存在操作局限。本研究探讨单侧双通道脊柱内镜(UBE)技术治疗TDH的临床疗效与安全性，报道1例49岁T8/9节段TDH男性患者的诊疗过程。患者采用UBE经椎间孔入路行椎间盘摘除术，术前术后采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及改良MacNab标准评价疗效。结果显示，手术顺利完成，患者术后疼痛症状显著缓解，VAS评分由术前8分降至末次随访0分，ODI指数由术前50%降至10%，右下肢肌力明显改善，复查MRI示突出髓核完全摘除，无手术相关并发症，改良MacNab疗效评价为优。本研究证实UBE技术治疗TDH具有创伤小、视野清晰、减压充分、安全性高的优势，为TDH的微创治疗提供了新的有效方案。

Abstract: Thoracic disc herniation (TDH) is a rare degenerative spinal disease with technically demanding, high-risk surgical management. Traditional open surgery causes significant trauma, while existing minimally invasive techniques have operational limitations. This study investigated the clinical efficacy and safety of unilateral biportal endoscopy (UBE) for TDH, reporting a 49-year-old male with T8/9 TDH treated with UBE transforaminal discectomy. Outcomes were assessed pre- and postoperatively via Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. The operation was uneventful. The patient’s pain was markedly relieved, with VAS score dropping from 8 preoperatively to 0 at final follow-up, and ODI from 50% to 10%. The muscle strength of his right lower extremity improved significantly. Postoperative MRI confirmed complete removal of the herniated nucleus pulposus, with no surgery-related complications, and the efficacy was rated excellent by modified MacNab criteria. This study confirms that UBE for TDH features minimal trauma, clear visualization, sufficient decompression and high safety, providing a new effective option for minimally invasive TDH treatment.