Abstract
Objective
Thoracic disc herniation in uncommon though its surgical management remains challenging topic. Surgery of such disc herniation represents less than 1%to 2% of operation for all disc disease. However, there is no consensus on the best approach and reports are based on small series.
Method:This study includes 82 patients with thoracic disc herniation operated in the past 20 years. 71 cases were operated via transthoracic or retopeitonral subdiphargmatic approach and nine through transfacet pedicle sparing route and Two with T1-T2 through low suprasternal notch corridor. In 12 instances two level discs were approached and in one three level, corpectomy was done in 3 cases. Autogenous graft was used in 18 cases, simple cages in 36, expandable cage in three and allograft in the remaining cases.
Result
Clinical outcome according to the thoracic JOA Score showed significant postoperative improvement. All transfacet pedicle sparing cases and two cases with isolated T1-T2 showed excellent result. six of the anterior group cases were complicated with unilateral paralysis of abdominal wall muscles. Intraoperative dural tear occurred in 4 cases which were sutured. All the patients in this group showed marked recovery except one who was temporarily deteriorated but gradually became better but not fully yet. In two other patients who were wrongly operated with laminectomy and screw fixation no recovery was seen in one but the other one has shown some recovery. In one case where the dura was covered with a thin layer of free fat graft for control of bleeding, overgrowth of fat was observed without any neurology till now.
Conclusion
Surgery of thoracic disc pose a challenge to the surgeon. The type of the surgery depends on the location of the disc. Centrally located ones and calcified hard ones are best achieved anteriorly But does located laterally via transfacet pedicle spring. Clinical outcome after surgery of a herniated thoracic disc proved successful, especially when the disc consistency, is evaluated before surgery and the affected level intraoperatively. Microscope, patience and the learning curve are important in achieving good result.