Treatment of symptomatic thoracic disc herniations with lateral interbody fusion.
BACKGROUND
Symptomatic thoracic herniated discs have historically been treated using open exposures (i.e., thoracotomy), posing a clinical challenge given the approach related morbidity. Lateral interbody fusion (LIF) is one modern minimally disruptive alternative to thoracotomy. The direct lateral technique for lumbar pathologies has seen a sharp increase in procedural numbers; however application of this technique in thoracic pathologies has not been widely reported.


METHODS
This study presents the results of three cases where LIF was used to treat symptomatic thoracic disc herniations. Indications for surgery included thoracic myelopathy, radiculopathy and discogenic pain. Patients were treated with LIF, without supplemental internal fixation, and followed for 24 months postoperatively.


RESULTS
Average length of hospital stay was 5 days. One patient experienced mild persistent neuropathic thoracic pain, which was managed medically. At 3 months postoperative all patients had returned to work and by 12 months all patients were fused. From preoperative to 24-month follow-up there were mean improvements of 83.3% in visual analogue scale (VAS), 75.3% in Oswestry Disability Index (ODI), and 79.2% and 17.4% in SF-36 physical (PCS) and mental component scores (MCS), respectively.


CONCLUSIONS
LIF is a viable minimally invasive alternative to conventional approaches in treating symptomatic thoracic pathology without an access surgeon, rib resection, or lung deflation.
Neuroscience Institute, Epworth Hospital, Melbourne, Victoria 3121, Australia ;
Gregory M
GM
Malham
Greg Malham Neurosurgeon, Melbourne, Victoria 3004, Australia.
Rhiannon M
RM
Parker
Complications; lateral; minimally invasive; spine; thoracotomy
J Neurosurg. 1954 Nov;11(6):525-38
13222162
J Neurosurg Spine. 2011 Feb;14 (2):250-60
21214308
Spine (Phila Pa 1976). 1995 Jul 15;20(14):1624-32
7570179
J Spinal Disord. 1998 Jun;11(3):183-91
9657540
J Neurosurg Spine. 2005 Sep;3(3):191-7
16235701
Br J Neurosurg. 1989;3(2):153-60
2679684
J Neurosurg Spine. 2010 Feb;12(2):221-31
20121360
Spine (Phila Pa 1976). 1979 Jan-Feb;4(1):41-6
432715
Neurosurgery. 2002 Nov;51(5 Suppl):S104-17
12234437
Spine (Phila Pa 1976). 1997 Mar 1;22(5):525-9; discussion 529-30
9076884
J Spinal Disord Tech. 2011 Aug;24(6):368-75
21150667
J Neurosurg. 1998 Aug;89(2):224-35
9688117
Spine (Phila Pa 1976). 2007 Sep 15;32(20):E581-4
17873799
Surg Laparosc Endosc. 1995 Oct;5(5):339-48
8845976
J Neurosurg. 1969 Oct;31(4):452-8
5349091
AJNR Am J Neuroradiol. 2005 Sep;26(8):2057-66
16155160
Neurosurg Focus. 2008;25(2):E5
18673053
Spine J. 2006 Jul-Aug;6(4):435-43
16825052
Neurosurgery. 1991 Feb;28(2):180-6
1997885
J Neurosurg Spine. 2012 Mar;16(3):264-79
22176427
Spine (Phila Pa 1976). 2010 Sep 1;35(19):E1000-5
20700083
J Neurosurg Spine. 2004 Jul;1(1):58-63
15291022
J Spinal Disord Tech. 2011 Jul;24(5):E40-8
21716068
J Comput Assist Tomogr. 1989 Mar-Apr;13(2):211-4
2925906
Neurosurg Focus. 2000 Oct 15;9(4):e11
16833241
Thorac Surg Clin. 2004 Aug;14(3):345-52
15382766
J Spinal Disord Tech. 2010 Apr;23 (2):79-88
20065866