Anterior or posterior approach of thoracic disc herniation? A comparative cohort of mini-transthoracic versus transpedicular discectomies

ABSTRACT Objectives: To present the clinical and radiographic results of patients with thoracic disc herniation treated by the posterior approach, according to location and type of hernia (à la carte). Methods: We evaluated thirteen patients (14 hernias) treated by the posterior approach. Eight (61.5%) patients were male and the mean age was 53 years (34-81). Clinical evaluation was performed by the Frankel and JOA modified scales. All the patients underwent the posterior approach, which was performed by facetectomy, transpedicular approach, transpedicular + partial body resection, costotransversectomy or costotransversectomy + reconstruction with CAGE. Results: The mean follow-up was 2 years and 6 months (11-77 months). Of the 14 operated hernias, six (43%) were lateral, 2 (14%) paramedian, and 6 (43%) central. Seven were soft (50%) and seven were calcified. The transfacet approach was carried out in 5 cases (36%), transpedicular in 1 case (7%), transpedicular + partial body resection in 4 (29%), costotransversectomy in 3 (21%), and costotransversectomy + CAGE in one case (7%). The majority of patients with lateral hernia (5/6) were subjected to transfacet decompression and in cases of central and paramedian hernias, all patients underwent decompression, which is more extensive. Conclusions: The posterior approach is safe and effective, and the best approach must be chosen based on location and type of the herniation and the surgeon's experience.

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Surgical management of thoracic disc herniation: anterior vs posterior approach

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.24969-18.2 ◽

2019 ◽

Author(s):

Ismail Oltulu ◽

Hemra Cil ◽

Sigurd Berven ◽

Dean Chou ◽

Aaron Clark ◽

...

Keyword(s):

Surgical Management ◽

Disc Herniation ◽

Posterior Approach ◽

Thoracic Disc Herniation ◽

Thoracic Disc

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Posterior Approach for Lower Thoracic Disc Herniation: A Report of 3 Cases

Orthopedics & Traumatology ◽

10.5035/nishiseisai.53.861 ◽

2004 ◽

Vol 53 (4) ◽

pp. 861-866

Author(s):

Kunihiko Uehara ◽

Katsuo Arakaki ◽

Tsugukazu Toma ◽

Hirokazu Nohara ◽

Fuminori Kanaya ◽

...

Keyword(s):

Disc Herniation ◽

Posterior Approach ◽

Thoracic Disc Herniation ◽

Thoracic Disc

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Modified eggshell procedure via posterior approach for sclerosing thoracic disc herniation: a preliminary study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-016-0438-2 ◽

2016 ◽

Vol 11 (1) ◽

Cited By ~ 7

Author(s):

Si-Dong Yang ◽

Qian Chen ◽

Sheng-Hua Ning ◽

Wen-Yuan Ding ◽

Da-Long Yang

Keyword(s):

Disc Herniation ◽

Posterior Approach ◽

Thoracic Disc Herniation ◽

Preliminary Study ◽

Thoracic Disc

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Transforaminal Endoscopic Foraminoplasty and Discectomy for the Treatment of a Thoracic Disc Herniation

World Neurosurgery ◽

10.1016/j.wneu.2016.02.086 ◽

2016 ◽

Vol 90 ◽

pp. 194-198 ◽

Cited By ~ 25

Author(s):

Ralf Wagner ◽

Albert E. Telfeian ◽

Menno Iprenburg ◽

Guntram Krzok ◽

Ziya Gokaslan ◽

...

Keyword(s):

Disc Herniation ◽

Thoracic Disc Herniation ◽

Thoracic Disc

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Surgical treatment of thoracic disc herniation using the anterior approach

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.64b3.7096401 ◽

1982 ◽

Vol 64-B (3) ◽

pp. 340-343 ◽

Cited By ~ 31

Author(s):

K Otani ◽

S Nakai ◽

Y Fujimura ◽

S Manzoku ◽

K Shibasaki

Keyword(s):

Surgical Treatment ◽

Disc Herniation ◽

Anterior Approach ◽

Thoracic Disc Herniation ◽

Thoracic Disc

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A Case of Thoracic Arachnoid Cyst with Thoracic Disc Herniation Presenting as Angina-like Pain

Spinal Surgery ◽

10.2531/spinalsurg.35.212 ◽

2021 ◽

Vol 35 (2) ◽

pp. 212-214

Author(s):

Nobuhiro Sasaki ◽

Atsuhiko Toyoshima ◽

Kiminori Sakurai ◽

Ryota Motoie ◽

Ryo Akiyama ◽

...

Keyword(s):

Arachnoid Cyst ◽

Disc Herniation ◽

Thoracic Disc Herniation ◽

Thoracic Disc

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Sleep Apnea and Unilateral Upper and Lower Extremity Allodynia as a Result of a Large Thoracic Disc Herniation: A Case Report

10.21203/rs.3.rs-233683/v1 ◽

2021 ◽

Author(s):

Tyler D. Alexander ◽

Anthony Stefanelli ◽

Sara Thalheimer ◽

Joshua E. Heller

Keyword(s):

Spinal Cord ◽

Sleep Apnea ◽

Sexual Dysfunction ◽

Lower Extremity ◽

Disc Herniation ◽

Cord Compression ◽

Thoracic Disc Herniation ◽

Lower Extremity Weakness ◽

Disc Herniations ◽

Thoracic Disc

Abstract BackgroundClinically significant disc herniations in the thoracic spine are rare accounting for approximately 1% of all disc herniations. In patients with significant spinal cord compression, presenting symptoms typically include ambulatory dysfunction, lower extremity weakness, lower extremity sensory changes, as well as bowl, bladder, or sexual dysfunction. Thoracic disc herniations can also present with thoracic radiculopathy including midback pain and radiating pain wrapping around the chest or abdomen. The association between thoracic disc herniation with cord compression and sleep apnea is not well described.Case PresentationThe following is a case of a young male patient with high grade spinal cord compression at T7-8, as a result of a large thoracic disc herniation. The patient presented with complaints of upper and lower extremity unilateral allodynia and sleep apnea. Diagnosis was only made once the patient manifested more common symptoms of thoracic stenosis including left lower extremity weakness and sexual dysfunction. Following decompression and fusion the patient’s allodynia and sleep apnea quickly resolved.ConclusionsThoracic disc herniations can present atypically with sleep apnea – a symptom which may resolve with surgical treatment.

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Management of single-level thoracic disc herniation through a modified transfacet approach: A review of 86 patients

Surgical Neurology International ◽

10.25259/sni_94_2021 ◽

2021 ◽

Vol 12 ◽

pp. 338

Author(s):

Samir Kashyap ◽

Andrew G. Webb ◽

Elizabeth A. Friis ◽

Paul M. Arnold

Keyword(s):

Disc Herniation ◽

Significant Risk ◽

Length Of Hospital Stay ◽

Thoracic Disc Herniation ◽

Estimated Blood Loss ◽

Surgeon Experience ◽

Thoracic Disc ◽

Stay Hospital ◽

Pain Improvement ◽

Selection Of

Background: Symptomatic thoracic disc herniation (TDH) is rare and does not typically resolve with conservative management. Traditional surgical management is the transthoracic approach; however, this approach can carry significant risk. Posterolateral approaches are less invasive, but no single approach has proven to be more effective than the other results are often dependent on surgeon experience with a particular approach, as well as the location and characteristics of the disc herniation. Methods: This was retrospective review of a prospectively collected database. Eighty-six patients with TDH treated surgically through the modified transfacet approach were reviewed and evaluated for pain improvement, Nurick grade, and neurological symptoms. Patients were followed for 12 months postoperatively; estimated blood loss, length of hospital stay, hospital course, and postoperative complications were also assessed. Results: All attempts at disc resection were successful. Most patients reported improvement in pain, sensory involvement, and strength. Seventy-nine patients had complete resolution of their symptoms while four patients had unchanged symptoms. Three patients experienced mild neurologic worsening postoperatively, but this resolved back to baseline. One patient experienced myelopathy during the postoperative period that resolved with steroid administration. The procedure was well tolerated with minimal complications. Conclusion: TDH can be managed surgically through a variety of approaches. The selection of approach is dependent on surgeon experience with an approach, the patient’s health, and the location and type of disc. The transfacet approach is safe and efficacious.

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