Treating thoracic-disc herniations: Do we always have to go anteriorly?
نویسندگان
چکیده
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine if there is a difference in outcome and complications in surgically managed patients with thoracic-disc herniations (TDH) undergoing a modified transfacet pedicle-sparing decompression and fusion (posteriorly) compared to those undergoing anterior transthoracic discectomies (anteriorly). METHODS Thirty-five consecutive operatively managed TDH underwent operative management between March 2003 and November 2009. Outcomes and complications were reviewed from patient records and x-rays assessing differences between those treated posteriorly and those treated anteriorly. RESULTS Twenty-four patients underwent posterior management for 35 TDH and ten patients underwent anterior management for twelve TDH. Mean age was 50 years in both groups. Body mass index (BMI) averaged 28.8 in the anterior group and 32.0 in the posterior group. Follow-up averaged 38 weeks with four patients lost to follow-up (all posterior). Major complications secondary to surgery occurred in three patients (30%) in the anterior group (pulmonary embolus, pneumonia, and wrong level surgery) and in seven patients (35%) in the posterior group (seroma, misplaced instrumentation requiring revision, recurrence requiring an additional operation, and four infections). No neurological complications occurred and all patients noted improvement from baseline. Average length of stay was 7.3 days in the anterior group and 4.2 days in the posterior group (P < .003). Final pain as assessed by visual analog scale (VAS) improved from 6.7 to 4.3 in the anterior group and 6.9 to 2.3 in the posterior group (P = .05). CONCLUSIONS Complication rates are similar between groups and are approach related. Posteriorly managed patients had greater improvement in pain and shorter length of stay. [Table: see text] The definition of the different classes of evidence is available on page 83.
منابع مشابه
Symptomatic thoracic disc herniations
than 1% of all vertebral disc operations.27 The incidence of thoracic disc–related spinal cord compression is estimated at approximately one case per million individuals per year.5 The use of computerized tomography and MR imaging has resulted in a significant increase in the detection and diagnosis of this lesion, perhaps providing more symptomatic patients expeditious treatment; however, like...
متن کاملVideo-assisted thoracoscopic surgery combined with a tubular retractor system for minimally invasive thoracic discectomy.
BACKGROUND Several approaches have been proposed for the treatment of thoracic disc herniations. Posterior approaches include transpedicular, costotransversectomy, and lateral extracavitary; anterior approaches include retropleural and transpleural thoracotomy and thoracoscopy. OBJECTIVE We present a novel minimally invasive approach to thoracic discectomies, combining thoracoscopy and a tubu...
متن کاملAnterior decompression and fusion for multiple thoracic disc herniation.
Multiple thoracic disc herniations are rare and there are few reports in the literature. Between December 1998 and July 2002, we operated on 12 patients with multiple thoracic disc herniations. All underwent an anterior decompression and fusion through a transthoracic approach. The clinical outcomes were assessed using the Frankel neurological classification and the Japanese Orthopaedic Associa...
متن کاملThoracic disc herniations: transthoracic, lateral, or posterolateral approach? A review.
BACKGROUND The choice between transthoracic, lateral, and posterolateral approaches to excise thoracic disc herniations remains controversial. METHODS The outcome of the three approaches was compared in seven of the authors' cases and in 324 other cases reported in the literature. RESULTS Partial or total neurological recovery was found in 93% after a transthoracic procedure versus 87% afte...
متن کاملIs back pain a diagnostic problem in clinical practices? A rare case report.
Multiple thoracic disc herniations are rare, and few reports exist in the literature. Diagnosis of these herniations is often missed because of their lack of specific clinical presentation. They may be treated conservatively or surgically. We presented a 35-year-old woman with five contiguous level thoracic disc herniations. She was admitted with upper back pain. Magnetic resonance imaging show...
متن کامل