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.
This is a preview of subscription content, log in to check access.
Conflict of interest
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 12:221–231PubMedCrossRefGoogle Scholar
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 83:971–976PubMedCrossRefGoogle Scholar
Mulier S, Debois V (1998) Thoracic disc herniation: transthoracic, lateral, or posterolateral approach? A review. Surg Neurol 49:599–608PubMedCrossRefGoogle Scholar
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):871–879PubMedCrossRefGoogle Scholar
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):79–88PubMedCrossRefGoogle Scholar
Bartels RH, Peul WC (2007) Mini-thoracotomy or thoracoscopic treatment for medially located thoracic herniated disc? Spine 32(20):E581–E584PubMedCrossRefGoogle Scholar
Burke TG, Caputy AJ (2000) Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique. Neurosurg Focus 9(4):e9PubMedCrossRefGoogle Scholar
Benzel EC, Lancon J, Kesterson L, Hadden T (1991) Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spin Disord 4(3):286–295CrossRefGoogle Scholar
Logue V (1952) Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 15:227–241PubMedCrossRefGoogle Scholar