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
