Surgical approach to single-level symptomatic thoracic disc herniations through costotransversectomy: A report of ten case series

Amico, Silvia; Scoscina, Dalila; Angeletti, Edoardo; Martiniani, Monia; Meco, Leonard; Specchia, Nicola; Gigante, AntonioPompilio

doi:10.4103/jcvjs.jcvjs_146_22

Cited by 1 publication

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“…Both approaches demonstrated favorable neurological outcomes, as reflected by improved Frankel scores, which were maintained long term. These findings are in line with Scoscina et al .,[ 8 ] who noted successful decompression and significant functional recovery post-costotransversectomy, and with Sivakumaran et al .,[ 9 ] whose work on transpedicular approaches similarly indicated favorable outcomes without postoperative complications.…”

Section: Discussionmentioning

confidence: 96%

Surgical options in thoracic disc herniation: Evaluating long-term outcomes of 21 cases based on a single-center 10-year experience

Thoma,

Charlton,

David

et al. 2024

Surgical Neurology International

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Background: Symptomatic thoracic disc herniation (TDH) is a rare pathology that is addressed with relatively challenging surgical approaches, the choice and technical execution of which have been well described in the literature. Interestingly, long-term outcomes, including surgical site pain-related disability, the need for instrumentation, and commonly occurring complications such as cerebrospinal fluid (CSF)-pleural fistula have not been widely addressed. Here, we address the complication profiles and long-term outcomes of different surgical approaches for TDH. Methods: We conducted a retrospective review of 21 consecutive patients who underwent surgery for TDH between 2000 and 2010. We assessed post-operative complications such as CSF-pleural fistulas, as well as long-term outcomes using Frankel grades, the EQ-5D-3L, and the Visual Analog Scale. We also looked at the need for instrumentation postoperatively. Results: 21 consecutive patients (13 females, 8 males) with a mean age of 55.3 years (Standard deviation 8.1) underwent thoracic discectomy for symptomatic TDH. Surgical approaches included posterolateral thoracotomy (52%, n = 11), costotransversectomy (43%, n = 9), and transpedicular (5%, n = 1). Herniations were classified as soft (38%, n = 8), calcified (38%, n = 8), or calcified-transdural (24%, n = 5). Postoperatively, all patients with calcifiedtransdural herniations undergoing posterolateral thoracotomy (100%, n = 5) developed CSF-pleural fistulas, which resolved spontaneously without the need for surgical re-exploration. 89% (n = 16) of patients exhibited sustained improvement in Frankel scores. Persistent wound site pain was reported by 50% (n = 7) of patients. Conclusion: Despite favorable neurological outcomes, patients with symptomatic TDHs can experience long-term surgical site pain, and therefore, a move toward minimally invasive exposure in such cases should be considered. Postoperative complications such as CSF-pleural fistulas are unlikely to require surgical intervention and thus can be managed conservatively.

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Section: Discussionmentioning

confidence: 96%