- Department of Neurosurgery, Riverside University Health System, Riverside, California, United States.
- Department of Clinical Imaging Research, Carle Illinois College of Medicine Beckman Institute of Advanced Science and Technology, Urbana, Illinois, United States.
- Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas,
- Department of Neurosurgery, Carle Neuroscience Institute, Urbana, Illinois, United States.
Correspondence Address:
Samir Kashyap, Department of Neurosurgery, Riverside University Health System, Riverside, California, United States.
DOI:10.25259/SNI_94_2021
Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Samir Kashyap1, Andrew G. Webb2, Elizabeth A. Friis3, Paul M. Arnold4. Management of single-level thoracic disc herniation through a modified transfacet approach: A review of 86 patients. 06-Jul-2021;12:338
How to cite this URL: Samir Kashyap1, Andrew G. Webb2, Elizabeth A. Friis3, Paul M. Arnold4. Management of single-level thoracic disc herniation through a modified transfacet approach: A review of 86 patients. 06-Jul-2021;12:338. Available from: https://surgicalneurologyint.com/surgicalint-articles/10940/
Abstract
Background: Symptomatic thoracic disc herniation (TDH) is rare and does not typically resolve with conservative management. Traditional surgical management is the transthoracic approach; however, this approach can carry significant risk. Posterolateral approaches are less invasive, but no single approach has proven to be more effective than the other results are often dependent on surgeon experience with a particular approach, as well as the location and characteristics of the disc herniation.
Methods: This was retrospective review of a prospectively collected database. Eighty-six patients with TDH treated surgically through the modified transfacet approach were reviewed and evaluated for pain improvement, Nurick grade, and neurological symptoms. Patients were followed for 12 months postoperatively; estimated blood loss, length of hospital stay, hospital course, and postoperative complications were also assessed.
Results: All attempts at disc resection were successful. Most patients reported improvement in pain, sensory involvement, and strength. Seventy-nine patients had complete resolution of their symptoms while four patients had unchanged symptoms. Three patients experienced mild neurologic worsening postoperatively, but this resolved back to baseline. One patient experienced myelopathy during the postoperative period that resolved with steroid administration. The procedure was well tolerated with minimal complications.
Conclusion: TDH can be managed surgically through a variety of approaches. The selection of approach is dependent on surgeon experience with an approach, the patient’s health, and the location and type of disc. The transfacet approach is safe and efficacious.
Keywords: Pedicle sparing, Thoracic disc herniation, Transfacet
INTRODUCTION
Thoracic disc herniation (TDH), while relatively rare in comparison to cervical and lumbar disc herniation, is not as uncommon as once thought. Advanced imaging techniques have revealed a prevalence of 11–37% in TDH patients who are asymptomatic and an incidence of 15.2% in postmortem patients.[
While the transthoracic approach is traditionally viewed, as the gold standard for surgical treatment of TDH, transpedicular, transdural, transfacet pedicle-sparing, and minimally invasive posterolateral approaches are gaining popularity, due to increased evidence of reductions in length of stay and shorter recovery time for patients without sacrificing neurological outcome.[
MATERIALS AND METHODS
Patient population
A retrospective review was conducted for patients with symptomatic single level TDHs who underwent surgical treatment at single institution between August 1993 and January 2019. All patients presented with symptoms of either radiculopathy or myelopathy. The patients’ preoperative clinic notes, operative reports, and postoperative follow-up clinic notes up to 12 months postoperation were also reviewed. Diagnosis was confirmed by MRI, CT myelogram, or both. Patients with centrally located or calcified disks were not treated via this approach.
Surgical technique
The surgical procedure was previously described.[
RESULTS
All attempts at resection of 86 single-level herniated discs were successful in (46 males and 40 females), ranging from 17 to 75 years of age. Pain relief was the preoperative symptom most consistently improved, with 82% of patients achieving good results (P < 0.005). About 57% of patients demonstrated improvement in their ability to ambulate, and 51% had postoperative sensory improvement. The most common level of herniation was T7-8[
DISCUSSION
Symptomatic TDHs are as rare as they are controversial in their management, ranging from conservative medical management (e.g., epidural steroid injections, physical therapy, and oral medications) to surgical management.[
In asymptomatic patients, the herniation will not spontaneously regress, but it will typically remain stable.[
Surgical management of TDH has remained controversial. The only approach that has effectively been abandoned is laminectomy due to its increased morbidity and mortality and lack of efficacy.[
Recent studies indicate that posterolateral approaches such as the transfacet pedicle-sparing approach result in shorter length of stay and decreased complications while still achieving similar outcomes.[
Minimally-invasive approaches are rapidly gaining popularity due to their ability to minimize blood loss, bone, and soft-tissue resection, and eliminate the need for fusion.[
CONCLUSION
Eighty-six patients with single-level TDHs were surgically managed through a modified transfacet approach. All patients presented with complaints of myelopathy, radiculopathy, or intractable back pain. About 82% of patients demonstrated postoperative pain reduction, and 57% of patients showed improved ability to ambulate. Sensory loss was less consistently improved with 51% of patients showing improvement. Complications occurred at a rate of <4.5%. Surgical management of herniated thoracic discs can be achieved through a modified transfacet approach in a safe and efficacious manner.
Declaration of patient consent
Patient’s consent not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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