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J Neurol Surg A Cent Eur Neurosurg 2024; 85(03): 240-245
DOI: 10.1055/a-2005-0620
Original Article

Clinical Outcome of Pedicle-Sparing Transfacet Diskectomy and Fusion with Segmental Instrumentation for Thoracic Disc Herniation

Keyvan Eghbal 
1   Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
,
Saber Zafarshamspour 
1   Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
2   Department of Surgery, Rafsanjan University of Medical Sciences, Kerman, Iran
,
Mohammadamin Sookhaklari
3   Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
,
Arash Saffarian
1   Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
,
Reza Taheri
1   Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract

Background Thoracic disk herniations (TDHs) are relatively rare compared with their cervical and lumbar counterparts. Posterior approaches allow for a simpler and less invasive surgery than anterior and lateral approaches. A pedicle-sparing transfacet approach was initially described in 1995, and modified in 2010. A few clinical series have reported the outcome of this procedure in patients with TDH. This study aimed to evaluate the outcomes and complications of pedicle-sparing transfacet diskectomy with interbody fusion and segmental instrumentation in patients with TDH.

Methods Twenty-one consecutive patients with symptomatic TDH referred to our tertiary care center were included in this retrospective study. All patients underwent a pedicle-sparing transfacet diskectomy with polyetheretherketone (PEEK) cage interbody fusion and short segmental instrumentation. Distribution of TDH, operative duration, blood loss, Visual Analog Scale (VAS) pain scores, Nurick grades, modified Japanese Orthopaedic Association (mJOA) scores, and fusion rate were assessed.

Results All patients had single-level herniations. The most common location was T12–L1 (38.1%), followed by T11–T12 (33.3%). All patients were successfully operated on with no cerebrospinal fluid (CSF) leaks or wrong-level surgery. The VAS scores significantly diminished from 4.9 (preoperatively) to 2 (18 months after surgery). The average mJOA score increased from 4.6 to 8.5, and the average Nurick grade decreased from 3.1 to 1.6. All patients reported significant improvement in quality of life relative to their preoperative status.

Conclusion A modified pedicle-sparing transfacet diskectomy combined with PEEK cage interbody fusion and segmental instrumentation offers a safe and less invasive approach for the treatment of TDHs.

Keywords

thoracic disk herniation - interbody fusion - PEEK cage - pedicle-sparing transfacet diskectomy - thoracic instrumentation


Publication History

Received: 15 May 2022

Accepted: 27 December 2022

Accepted Manuscript online:
30 December 2022

Article published online:
11 May 2023

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