Clinical Findings

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  A 29-year-old male patient presented with leg and back pain.

  
  
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  The leg pain was scored at 7/10 on the visual analog scale, whereas the back pain was scored at 5/10.

  
  
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  Chief complaint was mild paraparesis (grade IV/IV).

  
  
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  Preoperative imaging studies were conducted.

  
  
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  Magnetic resonance imaging (MRI) sagittal and axial views show a central disk extrusion at the T7-T8 level ( Fig. 12.1 ).

  
  
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  A computed tomographic (CT) scan shows a soft disk herniation at the T7-T8 level ( Fig. 12.2 ).

Preoperative Plan

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  It is determined that the patient will undergo a percutaneous endoscopic thoracic diskectomy (PETD) to correct the central disk extrusion at T7-T8.

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  A right-sided approach is selected, and the skin entry point is determined as 7.5 cm from the midline according to axial MRI ( Fig. 12.3 ).

Endoscopic Findings

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  The holmium:yttrium-aluminum-garnet (Ho:YAG) side-firing laser directed toward the posterior longitudinal ligament (PLL) can be seen in Fig. 12.9A . Notice the annulus tear site and that the herniated fragment can be seen through the tear.

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  Figure 12.9B shows the endoscopic view of the forceps removing the main extruded disk fragment.

  
  
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  After complete removal of the herniated disk fragment, the decompressed pulsating dura can be seen ( Fig. 12.9C ).