title: Surgical treatment of thoracic disc disease via minimally invasive lateral transthoracic trans/retropleural approach: analysis of 33 patients.
abstract: Thoracic disc herniations are associated with serious neurological consequences if not treated appropriately. Although a number of techniques have been described, there is no consensus about the best surgical approach. In this study, the authors report their experience in the operative management of patients with thoracic disc herniations using minimally invasive lateral transthoracic trans/retropleural approach. A series of 33 consecutive patients with thoracic disc herniations who underwent anterior spinal cord decompression followed by instrumented fusion through lateral approach is being reported. Demographic and radiographic data, perioperative complications, and clinical outcomes were reviewed. Forty disc levels in 33 patients (18F/15M; mean age, 52.9) were treated. Twenty-three patients presented with myelopathy (69 %), 31 had radiculopathy (94 %), and 31 had axial pain (94 %). Among patients with myelopathy, 14 (42.4 %) had bladder and/or bowel dysfunction. In the last eight cases (24 %), the approach was retropleural instead of transpleural. Patients were followed up for 18.2 months on average. The mean length of hospital stay was 5 days. None of the patients developed neurological deterioration postoperatively. Among 23 patients who had myelopathy signs, 21 (91 %) had improved postoperatively. The mean preoperative visual analog scale pain score, Oswestry Disability Index score, SF-36 PCS, and mental component summary scores were 7.5, 42.4, 29.6, and 37.5 which improved to 3.5, 33.2, 35.5, and 52.6, respectively. Perioperative complications occurred in six patients (18.1 %), all of which resolved uneventfully. Minimally invasive lateral transthoracic trans/retropleural approach is a safe and efficacious technique for achieving adequate decompression in thoracic disc herniations in a less invasive manner than conventional approaches.
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Osman Arikan
authors.initials: OA
authors.lastname: Nacar
authors.forename: Mustafa Onur
authors.initials: MO
authors.lastname: Ulu
authors.forename: Murat
authors.initials: M
authors.lastname: Pekmezci
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
mesh_terms: D000328:Adult; D000368:Aged; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000601:surgery; D010147:Pain Measurement; D010994:Pleura / Q000033:anatomy & histology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D013904:Thoracic Vertebrae / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult