Abstract
We present clinical findings, radiological characteristics and surgical modalities of various posterior approaches to thoracic disc herniations and report the clinical results in 27 consecutive patients. Within an 8-year period 27 consecutive patients (17 female, 10 male) aged 30–83 years (mean 53 years.) were surgically treated for 28 symptomatic herniated thoracic discs in our department. Six of these lesions (21%) were calcified. In all cases surgery was performed via individually tailored posterior approaches. We evaluated the pre- and postoperative clinical status and the complication rate in a retrospective study. Nearly one half of the lesions (46.4%) were located at the three lowest thoracic segments. Clinical symptoms included back pain or radicular pain (77.8%), altered sensitivity (77.8%), weakness (40.7%), impaired gait (51.9%) or bladder dysfunction (22%). Costotransversectomy was performed in 8 patients, 1 lateral extracavitary approach, 2 foraminotomies, 15 transfacet and/or transpedicular approaches and 2 interlaminar approaches were used for removing the pathologies. After a mean follow-up of 38.6 months (3–100 months), complete normalization or reduction of local pain was recorded in 87% of the patients and of radicular pain in 70% of the cases, increased motor strength could be achieved in 55%, sensitivity improved in 76.2% and improvement of myelopathy was noted in 71.4%. Two patients suffered from postoperative impairment of sensory deficits, which in one case was discrete. The overall recovery rate within the modified JOA score was 39.5%. In 1 patient, two revisions were required because of instability and a persisting osteophyte, respectively. The rate of major complications was 7.1% (2/28). Surgical treatment of thoracic disc herniations via posterior approaches tailored to the individual patient produces satisfying results referring to clinical outcome. Posterior approaches remain a viable alternative for a large proportion of patients with symptomatic thoracic disc herniations.
Similar content being viewed by others
References
Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR (2010) Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. J Neurosurg Spine 12:221–231
Stillerman CB, Chen TC, Day JD, Couldwell WT, Weiss MH (1995) The transfacet pedicle-sparing approach for thoracic disc removal: cadaveric morphometric analysis and preliminary clinical experience. J Neurosurg 83:971–976
Oskouian RJ, Johnson JP (2005) Endoscopic thoracic microdiscectomy. J Neurosurg Spine 3:459–464
Chen TC (2000) Surgical outcome for thoracic disc surgery in the postlaminectomy era. Neurosurg Focus 9 (4):Article 12
Maiman DJ, Larson SJ, Luck E, El-Ghatit A (1984) Lateral extracavitary approach to the spine for thoracic disc herniation: report of 23 cases. Neurosurgery 14:178–182
Lidar Z, Lifshutz J, Bhattacharjee S, Kurpad SN, Maiman DJ (2006) Minimally invasive, extracavitary approach for thoracic disc herniation: technical report and preliminary results. Spine J 6:157–163
Jho HD (1999) Endoscopic transpedicular thoracic discectomy. J Neurosurg 91(2 Suppl):151–156
Fessler RG, Sturgill M (1998) Complications of surgery for thoracic disc disease. Surg Neurol 49:609–618
Mulier S, Debois V (1998) Thoracic disc herniation: transthoracic, lateral, or posterolateral approach? A review. Surg Neurol 49:599–608
Anand N, Regan JJ (2002) Video-assisted thoracoscopic surgery for thoracic disc disease: classification and outcome study of 100 consecutive cases with a 2-year minimum follow-up period. Spine 27(8):871–879
Ayhan S, Nelson C, Gok B, Petteys RJ, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL, Sciubba DM (2010) Transthoracic surgical treatment for centrally located thoracic disc herniations presenting with myelopathy: a 5-year institutional experience. J Spinal Disord Tech 23(2):79–88
Bartels RH, Peul WC (2007) Mini-thoracotomy or thoracoscopic treatment for medially located thoracic herniated disc? Spine 32(20):E581–E584
Burke TG, Caputy AJ (2000) Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique. Neurosurg Focus 9(4):e9
Benzel EC, Lancon J, Kesterson L, Hadden T (1991) Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spin Disord 4(3):286–295
Logue V (1952) Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 15:227–241
Johnson JP, Filler AG, McBride DQ (2000) Endoscopic thoracic discectomy. Neurosurg Focus 9(4):E11
Patterson RH Jr, Arbit E (1978) A surgical approach through the pedicle to protruded thoracic discs. J Neurosurg 48:768–772
Han PP, Kenny K, Dickman CA (2002) Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures. Neurosurgery 51(5 Suppl):S88–S95
Larson SJ, Holst RA, Hemmy DC, Sances A Jr (1976) Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine. J Neurosurg 45:628–637
Rosenthal D, Rosenthal R, de Simone A (1994) Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine 19:1087–1091
Rosenthal D, Dickman CA (1998) Thoracoscopic microsurgical excision of herniated thoracic discs. J Neurosurg 89:224–235
Bordon G (2006) Die thorakoskopische Diskektomie Eine klinische Studie an 167 operierten Patienten. Dissertation. http://geb.uni-giessen.de/geb/volltexte/2007/4766/ (German, abstract in English)
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Börm, W., Bäzner, U., König, R.W. et al. Surgical treatment of thoracic disc herniations via tailored posterior approaches. Eur Spine J 20, 1684–1690 (2011). https://doi.org/10.1007/s00586-011-1821-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-011-1821-7