Surgical management of thoracic disc herniation: anterior vs posterior approach

Abstract

AIM: To compare outcomes and complications in patients with thoracic disc herniation (TDH) undergoing surgery with either the posterior or anterior approach. MATERIAL and METHODS: A total of 86 patients, with 98 symptomatic TDHs, who underwent surgery in a single institution between 2007 and 2016, were included. Overall, 68 patients were in the anterior and 18 were in the posterior group. Ten patients underwent multilevel TDH surgery. RESULTS: The groups were similar in age, sex, body mass index, and clinical symptoms. In the anterior group, 4 patients (5.9%) had major complications, and 26 (38.2%) had minor complications. In the posterior group, 6 patients (33.3%) had major complications, and 4 (22.2%) had minor complications. Visual analog scores at the final follow-up improved in both groups as compared to baseline preoperative scores (p>0.05). The rate of neurological improvement in patients with myelopathy was significantly higher in the anterior group (43/50) than in the posterior group (8/14) (p<0.05). CONCLUSION: The current study showed that higher rates of major complications in central and calcified paracentral TDHs are associated with posterior approaches when compared to anterior approaches. In addition, anterior approaches had superior neurological recovery and clinical outcomes. Therefore, we recommend the anterior approach for the treatment of calcified and/or non-calcified central and calcified paracentral TDH, while reserving posterior approaches for small non-calcified paracentral disc herniations.

Lower Neurological Risk with Anterior Operations Compared to Posterior Operations for Thoracic Disc Herniations

“…Surgical approach is mainly defined by the location of the neural compression, which is anterior in thoracic disc herniations-choosing a posterior approach does not target the lesion directly and carries an inherent risk of spinal cord manipulation. As such, an anterior approach is favored by some for large, calcified herniations and a posterior approach for smaller, uncalcified herniations, 15,20 as numerous studies have suggested that calcification of TDH may lead to intraoperative neurological injury, especially when the calcified disc occupies >40% of the spinal canal. 16,21 -23 In our study, it is possible that the higher rate of neural deficits was a result of posterior operations being used to treat large calcified discs paracentrally and/or centrally, which would lend support to the aforementioned recommendations.…”

Outpatient endoscopic resection of large calcified thoracic disc herniation with caudal displacement

“…Conclusively, we should also note that although these novel techniques can result in favorable outcomes, complex cases such as migrated large calcified thoracic discs can be challenging. [3][4][5][6] The importance of training in full-endoscopic procedures should be emphasized, and these cases are likely best reserved for surgeons with sufficient clinical experience and volume in full-endoscopic spine procedures. 7…”

Assessment of thoracic disk herniation by using virtual noncalcium dual-energy CT in comparison with standard grayscale CT

“…Disk herniation represents a frequent disease, particularly affecting people aged 30 to 50 with an incidence of about 5 to 20 cases per 1000 adults annually [1]. While lumbar disk herniations are most frequently encountered, thoracic disk herniations are rare accounting for less than 1% of all cases [2][3][4][5]. However, thoracic disk herniations can result in miscellaneous clinical symptoms including severe myelopathy [4].…”

“…While lumbar disk herniations are most frequently encountered, thoracic disk herniations are rare accounting for less than 1% of all cases [2][3][4][5]. However, thoracic disk herniations can result in miscellaneous clinical symptoms including severe myelopathy [4]. Moreover, spinal nerve root impingement can cause severe pain and neurological symptoms.…”