Abstract
Purpose Thoracic disk herniation (TDH) is relatively uncommon. The surgical approach differs
from lumbar or cervical disk herniations because serious complications are associated
with the posterior approach in TDH. Various different approaches have been tried for
the surgical removal of TDH, but most of them are cumbersome surgeries such as thoracotomy
or thoracoscopic or anterior approaches with or without instrumentation. The requirement
for a simplified, familiar, and less morbid surgery has motivated some new approaches.
A pedicle-sparing transfacet approach (PSTA) was first described in 1995, but to date
no sufficient clinical series has been presented in the literature to report on its
feasibility and applicability along with complication and morbidity rates. Our objective
was to assess the feasibility of the PSTA under microscopic visualization in a cumulative
clinical series.
Methods Twenty-eight consecutive patients with no response to medical/physical treatment
with and without motor weakness of their lower extremities underwent the surgery for
TDH via the PSTA under microscopic visualization by a senior neurosurgeon. Preoperative
and postoperative low extremity muscle strength, sensation, reflex status, and visual
analog scores (VAS), Nurick grades, and complications were recorded. Postoperative
MRI within 24 hours was performed. The median follow-up period was 33 months.
Results The patients consisted of 16 men and 12 women. The disk levels ranged from T8 to
T12–L1. All but one patient received one-level surgery. One patient was operated on
two levels. A total of 21 patients had paracentral disk herniations; the other 7 had
central disk herniations. Postoperative MRI showed satisfactory removal of disk herniation
in all but one patient. There was no infection, wrong level surgery, or incidental
durotomy. Median VAS levels significantly improved after the operation from 7.4 to
2.3. The Nuric grades decreased from 2.7 to 1.6 after surgery.
Conclusions The microsurgical PSTA is a safe and feasible technique with a significantly shorter
surgeon's learning curve. The approach offers a wide surgical window; moreover, it
can by increased by tilting the surgical table allowing satisfactory decompression
of TDH. After PSTA, segmental instrumentation is not required.
Keywords
microdiskectomy - thoracic disk herniation - thoracic spinal stenosis - posterior
thoracic decompression - spinal cord
