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

Abstract

Study Design: Retrospective observational study. Objectives: Thoracic disc prolapse (TDP) surgeries have reported complications ranging from paraplegia to approach related complications. This study is to present a series of TDP patients surgically treated with transforaminal thoracic interbody fusion (TTIF). Emphasis on surgical technique and strategies to avoid complications are analyzed. Methods: Eighteen patients with TDP were included. Imagings were analyzed for end-plate changes and calcification. Type of disc prolapse (central/para-central) and percentage of canal occupancy were noted. Objective outcome was quantified with Visual Analogue Scale (VAS), modified Nurick’s grade, and ASIA (American Spinal Injury Association) score. All complications were noted. Results: Eighteen patients (average age 43.65 years) having total 22 levels operated, that included double level (n = 2) and missed level (n = 2) are reported. All patients had myelopathy. Calcification of disc (n = 13), central disc prolapses (n = 9), para-central (n = 11) and more than 50% canal occupancy (n = 8) were noted. VAS back pain, modified Nurick’s grade and ASIA grade improved significantly in all patients. One patient had postoperative transient deficit. The functional score achieved its maximum at 1 year follow-up and remained static at final follow-up of 65.05 months. Union was achieved in all patients. Conclusions: The most important factor for outcome in TDP is the technical aspect of avoiding cord manhandling and avoiding wrong level surgeries. TTIF is not devoid of complications but can give good results to posterior approach trained surgeons.

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“…Consistent with previous reports by Machino et al 14 and Krishnan et al, 17 arthrodesis was achieved in all patients. Our findings demonstrate that the pedicle-sparing transfacet approach, when combined with a transforaminal interbody and segmental fusion, offers a high fusion rate and good postoperative stability.…”

Expanded Indications of Full Endoscopic Spine Sugery

“…ii) Thoracic FESS Thoracic disc herniation (TDH) is an uncommon entity although frequently disabling when symptomatic. Its treatment has been approached classically by open circumferential approaches [148][149][150][151][152] . But, the thoracic cord doesn't tolerate manipulation unlike lumbar.…”