Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle–Sparing Decompression With Segmental Instrumentation and Interbody Fusion

Abstract

Study Design:Retrospective consecutive case series.Objective:The objective of this case series was to demonstrate the safety of a modified transfacet pedicle–sparing decompression and instrumented fusion in patients with thoracic disc herniations (TDHs).Methods:Consecutive patients undergoing operative management of TDH from July 2007 to December 2011 using a posterior unilateral modified transfacet pedicle–sparing approach were identified. All patients underwent open or minimally invasive modified transfacet pedicle–sparing discectomy and segmental instrumentation with interbody fusion, performed by four different surgeons. Pre- and postoperative visual analog scale (VAS) pain scores, Nurick grade, and American Spinal Injury Association Impairment Scale (AIS) were analyzed from a retrospective chart review. Estimated blood loss and complications were also obtained.Results:Fifty-one patients were included that had operations for TDH. Thirty-nine patients had single level decompression and 12 had multilevel decompression. The total number of levels operated on was 64. Five patients were treated with minimally invasive surgery. A herniated disc level of T11-12 (n = 17) was treated most often. One major complication of epidural hematoma occurred. Minor complications such as malpositioned hardware, postoperative hematoma, wound infection, pseudoarthrosis, and pulmonary complications occurred in a few patients. Follow-up ranged from 1 to 46 months with 1 patient lost to follow-up. From preoperative to final postoperative: mean VAS scores improved from 8.31 to 4.05, AIS in all patients remained stable or improved, and Nurick scores improved from 3 to 2.6 on average. No intraoperative or permanent neurological deficit occurred.Conclusion:In our surgical series, 51 consecutive patients underwent modified transfacet pedicle–sparing approach to TDHs and experienced improvement of functional status as well as improvement of objective pain scales with no neurological complications. The posterior unilateral modified transfacet pedicle–sparing decompression and instrumented fusion approach to the thoracic spine is a safe and reproducible procedure for the treatment of TDHs.

Transforaminal Thoracic Interbody Fusion for Thoracic Disc Prolapse: Surgicoradiological Analysis of 18 Cases

“…level (n ¼ 8) and occurrence was predominantly in males (17,94.44%) in their 40s. Only laminectomy did not reduce ventral forces on the spinal cord and spinal cord manipulation was not tolerated well during discectomy with this approach.…”

“…Customized long, down-going, and various angled curettes to achieve a unilateral decompression by a medial sparing transfacetal approach is also reported along with a novel osteotome in similar segmental fusion-decompression method. 15 – 17 If they provide equal ventral exposure like anterior approach, nonanterior approaches for TDP can be favoured. 30 This is quite evident by all strategies we adopted, adequate ventral exposure can be achieved.…”

“…Both-side access is classically reported by Bransford et al 8 Bilateral approach from both sides of the disc has been acknowledged by some and refuted by others. 15 – 17 The T incision and /or LECA increase the ventral non manipulative reach of the surgical instruments. Another notable thing is that the interbody fusion part is completed before the intracanalicular decompression is started.…”

“… 9 However, posterior approach decompression with or without fusion has been advocated as an alternative and successful treatment modality in other reports. 10 – 17 One of the main problems is that an accomplished spine surgeon will see very low numbers of TDP in his life time. This makes long series reporting less likely.…”

Surgery of Thoracic Disc Herniation: A Systematic Review of English-Language Literature

“…Авторы публикаций, посвященных заднему доступу, видят его преиму-щество не только в меньшей частоте осложнений, но и в лучшей возможности контролировать эпидуральное пространство, его венозные сосуды и состояние твердой мозговой оболочки [7,19,22]. Разнообразие задних доступов расширяет возможности их применения и позволяет удалять не только мягкотканные латерально расположенные, но и медиальные оссифицированные грыжи диска [7,8,20,21,22,25].…”