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

Abstract

Purpose: Thoracic disc herniations (TDHs) are 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 outcomes of this procedure in patients with TDH. This study evaluated the outcomes and complications of pedicle-sparing transfacet discectomy 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 pedicle-sparing transfacet discectomy with PEEK cage interbody fusion and short segmental instrumentation. The distribution of TDH, operative duration, blood loss, Visual Analog Scale pain scores, Nurick grades, mJOA scores, and fusion rate were assessed. Results: All patients had single-level herniation. The most common location was T12-L1 (38.1%) followed by T11-T12 (33.3%). All patients were successfully operated on with no CSF leaks or wrong-level surgery. VAS scores significantly diminished from 4.9 preoperatively to 2 eighteen months after surgery. The average mJOA score increased from 4.6 to 8.5, whereas the average Nurick grade decreased from 3.1 to 1.6. All patients reported significant improvement in the quality of life relative to their preoperative status. Conclusion: A modified pedicle-sparing transfacet discectomy combined with PEEK cage interbody fusion and segmental instrumentation offer a safe and less invasive approach for the treatment of thoracic disc herniations.