Posterolateral approach for thoracic disc herniation

English Keywords:Thoracic disc herniation  Posterolateral entrance  Operative treatment  Efficacy

English Abstract:

  【Abstract】 Objectives: To evaluate the surgical outcome of posterolateral approach for treatment of thoracic disc herniation. Methods: 24 patients with thoracic disc herniation(TDH) were treated surgically from January 2006 to August 2012. There were 15 males and 9 females, with the age arranging from 37 to 64 years, (average, 45.3 years), duration of onset was from 4 months to 2 years, with an average of 14 months. All patients had single level involved which presented with central herniation in 16 cases and paracentral in 8 cases, hard disc was noted in 18 cases, soft disc in 6 cases. The lesion was T7/8 in 2 cases, T8/9 in 4 cases, T9/10 in 4 cases, T10/11 in 5 cases and T11/2 in 9 cases. Of them, 3 cases were associated with ossification of thoracic ligament flavum, 4 cases with ossification of posterior longitudinal ligament. Pre and postoperative JOA score and Otani grading were recorded. The fusion status was evaluated by Bridwell. Results: All surgeries were successfully performed, and no neurological deficit was noted. All patients had good skin healing except for skin problem in 1 case. 1 of 3 cases with CSF leakage due to dural tearing was cured by subarachnoid drainage. 24 cases were followed up for 0.5 to 3.5 years with an average of 2.1 years. The clinical symptoms relieved significantly, with no neurological deterioration and instability noted during follow-up. The preoperative JOA score was 4.4±2.4 points, the postoperative JOA score was 8.7±2.3 points at 3 months, 9.0±2.3 points at the last follow-up, which showed significant differences(P<0.05), the clinical improvement rate was(74.6±16.6)%. According to Otani grading, excellent was noted in 9 cases, good in 11 cases, fair and poor in 2 cases, respectively, with an excellent and good rate of 83.3%. One of two cases suffering paraplegia showed no obvious improvement, while the other improved from Frankel A to C at 6 months after operation. No instrument failure was observed. According to Bridwell criteria, all cases got grade Ⅱ or Ⅲ at postoperative 3 months; 6 cases got grade Ⅰ, the other cases got grade Ⅱ at postoperative 6 months; all cases got grade Ⅰ at postoperative 9 months. Conclusions: The posterolateral approach is effective for thoracic disc herniation.