[Costotransversectomy and interbody fusion for treatment of thoracic dyscopathy].
BACKGROUND
Surgical treatment of a thoracic discopathy comprises 4% of all surgeries performed for discopathy. Therefore, analysis of efficacy of particular operative methods used in that scope is limited. We present our analyze modification of costotransversectomy with policarbone cage interbody fusion as the contribution to discussion on optimal operative treatment of thoracic discopathy.


METHODS
Results of the operative treatment of 14 cases of a thoracic discopathy are analyzed. In 12 cases neurological examination revealed radiculopathy and in 2 cases upper motor neuron involvement. All patients underwent MRI for estimation of level and morphology of discopathy. In one case there was two-level dyscopathy and in the other cases there was one-level discopathy localized in the region between fifth and twelve thoracic vertebrae. The follow up period was of 10 months to 6 years (mean 2 years and four months). During the surgery lateral upper aspect of the intervertebral disc on a one side was exposed. It was accomplished by removal of the head of the rib and the upper aspect of the pedicle located caudally to the intervertebral disc. The policarbone cage was introduced into the intervertebral space after discectomy.


RESULTS
In the case with sudden preoperative deterioration of the lower extremities strength there was further postoperative deterioration. During follow up, continuous improvement was observed. In the 12th postoperative month the weakness was minimal. In the other cases immediate postoperative resolution of the pain syndrome and neurological deficits was observed. Postoperative imaging studies reveled appropriate decompression of the spinal canal and localization interbody implant.


CONCLUSIONS
1. Costotransversectomy approach leads to sufficient exposition of the anterior aspect of the spinal canal. 2. Our modification of interbody fusion with policarbone cage gives good results in fusion of compromised motion unit. It makes the approach more attractive in the light of remote surgery effects.
Klinika Neurochirurgii i Neurochirurgii Dzieciecej Pomorskiej Akademii Medycznej w Szczecinie ul. Unii Lubelskiej 1, 71-252 Szczecin.
Leszek M
LM
Sagan
Lukasz
L
Madany
Marek
M
Lickendorf
D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D010149:Postoperative Pain / Q000209:etiology; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome