Skip to main content
SpringerLink
Log in

Costotransversectomy in the Surgical Treatment of Mediolateral Thoracic Disk Herniations: Long-Term Results and Recent Minimally Invasive Technical Adjuncts

  • Chapter
  • First Online:
The Funnel: From the Skull Base to the Sacrum

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 135))

  • 310 Accesses

Abstract

Thoracic herniated disks are relatively rare. They account for approximately 2% of all intervertebral herniated disks in large series. Traditional surgery via laminectomy has frequently yielded disappointing results, although the recent literature reports that anterior calcified thoracic herniation was successfully treated with this approach. This issue has encouraged a search for alternatives, such as anterolateral, lateral, and posterolateral approaches to the thoracic spine. From January 2009 to December 2019, we selected 66 patients harboring a symptomatic median-paramedian herniated disk at the level of the thoracic spine, treated at the authors’ institutions. The present experience would give further support to the use of costotrasversectomy, along with its “mini-invasive” modifications, as a suitable and safe approach for thoracic disk disease. Although we must admit that endoscopy is likely to become the gold standard of surgical method in the future and that the anterior approach with mini-toracotomy without rib removal will become popular, the future scenario could certainly reserve an important place for the approach we have used in the surgical management of this challenging spinal pathology, mainly because of the approach’s versatility and short learning curve.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bouthors C, Benzakour A, Court C. Surgical treatment of thoracic disc herniation: an overview. Int Orthop. 2019;43(4):807–16. https://doi.org/10.1007/s00264-018-4224-0. Epub 2018 Nov 8.

    Article  PubMed  Google Scholar 

  2. Ridenour TR, Haddad SF, Hitchon PW, et al. Herniated thoracic disks: treatment and outcome. J Spinal Disord. 1993;6(3):218–24.

    Article  CAS  PubMed  Google Scholar 

  3. Sagar B, Sharma, Kim J-S. A review of minimally invasive surgical techniques for the management of thoracic disk herniations. Neurospine. 2019;16(1):24–33.

    Article  Google Scholar 

  4. El-Kalliny M, Tew JM, van Loveren H, et al. Surgical approaches to thoracic disc herniations. Acta Neurochir. 1991;111(1-2):22–32.

    Article  CAS  PubMed  Google Scholar 

  5. Rossitti S, Stephensen H, Ekholm S, von Essen C. The anterior approach to high thoracic (T1-T2) disc herniation. Br J Neurosurg. 1993;7(2):189–92.

    Article  CAS  PubMed  Google Scholar 

  6. Arts MP, Bartels RH. Anterior or posterior approach of thoracic disc herniation. A comparative cohort of mini-transthoracic versus transpedicular discectomies. Spine J. 2014;14(8):1654–62. https://doi.org/10.1016/j.spinee.2013.09.053.

    Article  PubMed  Google Scholar 

  7. Nakhla J, Bhashyam N, De la Garza RR, Nasser R, Kinon MD, Yassari R. Minimally invasive transpedicular approach for the treatment of central calcified thoracic disc disease: a technical note. Eur Spine J. 2018;27(7):1575–85. https://doi.org/10.1007/s00586-017-5406-y. Epub 2017 Dec 15.

    Article  PubMed  Google Scholar 

  8. Deviren V, Kuelling FA, Poulter G, Pekmezci M. Minimal invasive anterolateral transthoracic transpleural approach: a novel technique for thoracic disc herniation. A review of the literature, description of new surgical technique and experience with first 12 consecutive patients. J Spinal Disord Tech. 2011;24(5):E40–8. https://doi.org/10.1097/BSD.0b013e31822af6f.

    Article  PubMed  Google Scholar 

  9. Lubelski D, Abdullah KG, Mroz TE, et al. Lateral extracavitary vs.costotrasversectomy approaches to the thoracic spine: reflections on lessons learned. Neurosurgery. 2012;71(6):1096–102. https://doi.org/10.1227/NEU.0b013e3182706102.

    Article  PubMed  Google Scholar 

  10. Oltulu I, Cil H, Ulu MO, Deviren V. Clinical outcomes of symptomatic thoracic disk herniations treated surgically through minimally invasive lateral transthoracic approach. Neurosurg Rev. 2019;42(4):885–94. https://doi.org/10.1007/s10143-018-01064-2. Epub 2019 Jan 8.

    Article  PubMed  Google Scholar 

  11. Uribe JS, Smith WD, Pimenta L, et al. Minimally invasive lateral approach for symptomatic thoracic disc herniation: initial multicentre clinical experience. J Neurosurg Spine. 2012;16(3):264–79. https://doi.org/10.3171/2011.10.SPINE11291.

    Article  PubMed  Google Scholar 

  12. Baranowska A, Baranowski P, Baranowska J, Jarzyński T. Evaluation of the results of posterior approach in thoracic disc herniation surgery. Pol Merkur Lekarski. 2020;48(287):318–22.

    PubMed  Google Scholar 

  13. Liu W, Yao L, Li X, Tian Z, Ning C, Yan M, Wang Y. Percutaneous endoscopic thoracic discectomy via posterolateral approach: a case report of migrated thoracic disc herniation. Medicine. 2019;98(41):e17579. https://doi.org/10.1097/MD.0000000000017579.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Quillo-Olvera J, Kim JS. A novel, minimally invasive hybrid technique to approach intracanal herniated thoracic discs. Oper Neurosurg. 2020;19(2):E106–16. https://doi.org/10.1093/ons/opz362.

    Article  Google Scholar 

  15. Sagan LM, Madany L, Lickendorf M. Costotrasversectomy and interbody fusion for treatment of thoracic dyscopathy. Ann Acad Med Stetin. 2007;53(1):23–6.

    PubMed  Google Scholar 

  16. Kim KD, Babbitz JD, Mimbs J. Imaging-guided costotrasversectomy for thoracic disc herniation. Neurosurg Focus. 2000;9(4):e7.

    Article  CAS  PubMed  Google Scholar 

  17. Pei B, Sun C, Xue R, Xue Y, Zhao Y, Zong YQ, Lin W, Wang P. Circumferential decompression via a modified costotransversectomy approach for the treatment of single level hard herniated disc between T10-L1. Orthop Surg. 2016;8(1):34–43. https://doi.org/10.1111/os.12223.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Falavigna A, Piccoli CL. Minimally invasive approaches for thoracic decompression from discectomy to corpectomy. J Neurosurg Sci. 2013;57(3):175–92.

    CAS  PubMed  Google Scholar 

  19. Wagner R, Telfeian AE, Iprenburg M, Krzok G, Gokaslan Z, Choi DB, Pucci FG, Oyelese A. Transforaminal endoscopic foraminoplasty and discectomy for the treatment of a thoracic disc herniation. World Neurosurg. 2016;90:194–8. https://doi.org/10.1016/j.wneu.2016.02.086. Epub 2016 Feb 28.

    Article  PubMed  Google Scholar 

  20. Hur JW, Kim JS, Cho DY, Shin JM, Lee JH, Lee SH. Video-assisted thoracoscopic surgery under O-arm navigation system guidance for the treatment of thoracic disk herniations: surgical techniques and early clinical results. J Neurol Surg A Cent Eur Neurosurg. 2014;75(6):415–21. https://doi.org/10.1055/s-0034-1368690. Epub 2014 Feb 25.

    Article  PubMed  Google Scholar 

  21. Chiu JC, Clifford TJ, Sison R. Percutaneous microdecompressive endoscopic thoracic discectomy for herniated thoracic discs. Surg Technol Int. 2002;10:266–9.

    PubMed  Google Scholar 

  22. Li ZZ, Zhao HL, Cao Z, Shang WL, Hou SX. Technical notes and clinical efficacy analysis of full-endoscopic thoracic discectomy via transforaminal approach. Zhonghua Yi Xue Za Zhi. 2020;100(4):279–85. https://doi.org/10.3760/cma.j.issn.0376-2491.2020.04.008.

    Article  CAS  PubMed  Google Scholar 

  23. Roselli R, Iacoangeli M, Pompucci A, Trignani R, Restuccia D, Di Lazzaro V, Scerrati M. Anterior cervical epidural abscess treated by endoscopy-assisted minimally invasive microsurgery via posterior approach. Minim Invasive Neurosurg. 1998;41(3):161–5. https://doi.org/10.1055/s-2008-1052034.

    Article  CAS  PubMed  Google Scholar 

  24. Ruetten S, Hahn P, Oezdemir S, Baraliakos X, Merk H, Godolias G, Komp M. Full-endoscopic uniportal decompression in disc herniations and stenosis of the thoracic spine using the interlaminar, extraforaminal, or transthoracic retropleural approach. J Neurosurg Spine. 2018;29(2):157–68. https://doi.org/10.3171/2017.12.SPINE171096. Epub 2018 Jun 1.

    Article  PubMed  Google Scholar 

  25. Court C, Mansour E, Bouthors C. Thoracic disc herniation: surgical treatment. Orthop Traumatol Surg Res. 2018;104(1S):S31–40. https://doi.org/10.1016/j.otsr.2017.04.022. Epub 2017 Dec 7.

    Article  CAS  PubMed  Google Scholar 

  26. Otani K, Nakai S, Fujimura Y, et al. Surgical treatment of thoracic disc herniation using the anterior approach. J Bone Joint Surg Br. 1982;64(3):340–3.

    Article  CAS  PubMed  Google Scholar 

  27. Nishimura Y, Thani NB, Tochige S, et al. Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: clinical article. J Neurosurg Spine. 2014;21(4):568–76. https://doi.org/10.3171/2014.6.SPINE13682.

    Article  PubMed  Google Scholar 

  28. Noureldine MHA, Pressman E, Krafft PR, Molcanyi M, Tran ND, Greenberg MS, Alikhani P. Management of thoracic disc herniation using the mini-open retropleural approach: technique illustration and clinical outcomes of 33 patients from a single academic center. Oper Neurosurg. 2020;19(5):567–81. https://doi.org/10.1093/ons/opaa228.

    Article  Google Scholar 

  29. Russo A, Balamurali G, Nowicki R, et al. Anterior thoracic foraminotomy through mini-thoracotomy for the treatment of giant thoracic disc herniations. Eur Spine J. 2012;21(Suppl 2):212–20. https://doi.org/10.1007/s00586-012-2263-6.

    Article  PubMed Central  Google Scholar 

  30. Visocchi M, Masferrer R, Sonntag VHK, Dickman CA. Thoracoscopic approaches to the thoracic spine. Acta Neurochir. 1998;140(8):737–43; discussion 743–744. https://doi.org/10.1007/s007010050174.

    Article  CAS  PubMed  Google Scholar 

  31. Ogden TA, Kaiser M, Fessler RG. Minimally invasive approaches to thoracic disk herniations. Best evidence for spine surgery: cardinal cases. 2012.

    Google Scholar 

  32. Lowe SR, Alshareef MA, Kellogg RT, Eriksson EA, Kalhorn SP. A novel surgical technique for management of giant central calcified thoracic disk herniations: a dual corridor method involving tubular transthoracic/retropleural approach followed by a posterior transdural diskectomy. Oper Neurosurg. 2019;16(5):626–32. https://doi.org/10.1093/ons/opy225.

    Article  Google Scholar 

  33. Soda C, Faccioli F, Marchesini N, Ricci UM, Brollo M, Annicchiarico L, Benato C, Tomasi I, Pinna GP, Teli M. Trans-thoracic versus retropleural approach for symptomatic thoracic disc herniations: comparative analysis of 94 consecutive cases. Br J Neurosurg. 2021;35(2):195–202. https://doi.org/10.1080/02688697.2020.1779660. Epub 2020 Jun 19.

    Article  PubMed  Google Scholar 

  34. Brotis AG, Tasiou A, Paterakis K, Tzerefos C, Fountas KN. Complications associated with surgery for thoracic disc herniation: a systematic review and network meta-analysis. World Neurosurg. 2019;132:334–42. https://doi.org/10.1016/j.wneu.2019.08.202. Epub 2019 Sep 5.

    Article  PubMed  Google Scholar 

  35. Wessell A, Mushlin H, Fleming C, Lewis E, Sansur C. Thoracic discectomy through a unilateral transpedicular or costotransversectomy approach with intraoperative ultrasound guidance. Open Neurosurg. 2019;17(3):332–7. https://doi.org/10.1093/ons/opy348.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Bioorganic Chemistry, Neuroscience, Russian Academy of Sciences, Moscow, Russia

    Aldo Spallone, Maurizio Gladi, Rossella Fasinella, Alexey Belogurov & Maurizio Iacoangeli

  2. NCL-Neurological Center of Latium, Rome, Italy

    Aldo Spallone, Maurizio Gladi, Rossella Fasinella, Alexey Belogurov & Maurizio Iacoangeli

  3. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

  4. Skull Base Surgery Unit, Campus Bio-Medico University, Rome, Italy

    Fabio Greco

  5. Institute of Neurosurgery, Le Marche Polytechnic University and Polyclinic, Ancona, Italy

    Francesco Signorelli

Authors
  1. Aldo Spallone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Massimiliano Visocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabio Greco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Signorelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maurizio Gladi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rossella Fasinella
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alexey Belogurov
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maurizio Iacoangeli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maurizio Iacoangeli .

Editor information

Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Spallone, A. et al. (2023). Costotransversectomy in the Surgical Treatment of Mediolateral Thoracic Disk Herniations: Long-Term Results and Recent Minimally Invasive Technical Adjuncts. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_57

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-36084-8_57

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-36083-1

  • Online ISBN: 978-3-031-36084-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation