Posterior lateral approach of interbody fusion and internal fixation for thoracic intervertebral disc herniation

English Keywords:Thoracic intervertebral disc herniation  Spinal decompression  Interbody fusion  Posterior lateral approach  Lateral anterior approach

English Abstract:

  【Abstract】 Objectives: To observe the outcome of interbody fusion and internal fixation through posterior lateral approach for thoracic intervertebral disc herniation. Methods: From January 2009 to August 2015, 47 cases of thoracic intervertebral disc herniation were treated with spinal decompression and interbody fusion, 26 cases were treated by posterior lateral approach and 21 cases by lateral anterior approach. Preoperative age, sex distribution, course of disease, lesion segment, type of herniation, spinal cord compression, clinical manifestations, follow-up time differences were not statistically significant between 2 groups(P>0.05). Comparation of operation time, blood loss, complications and surgery between two surgeries were recorded; clinical efficacy was assessed by Otani grading at 6 months after operation; the pain relief was assessed by visual analogue scale(VAS) at preoperation and 3 days and 6 months after operation; recovery with improvement in the neurological function of spinal cord was evaluated by JOA score and the neurological functional Frankel grading at 6 months after operation, the extent of spinal canal decompression was assessed by imaging measurement canal sagittal diameter residual rate; intervertebral fusion was assessed by CT scan reconstruction; fixation was evaluated by dynamic X-ray films. Results: The operation time, blood loss, incision length and length of stay in the posterior lateral approach group were better than those in the anterior approach group, and the difference was statistically significant(P<0.05). There were 4 cases of pleural effusion, 4 cases of pneumonia, 2 cases of cerebrospinal fluid leakage and 5 cases of intestinal paralysis in the anterior approach group. There was no complication noted in the posterior lateral approach group. The difference was statistically significant(P<0.05). According to the Otani classification, 6 months after surgery, the excellent rates of the two groups were not statistically significant(P>0.05). As for the pain VAS scores at postoperative 3 days, the lateral approach group was better than the anterior lateral approach group, the difference was statistically significant(P<0.05). After operation, all patients had better VAS scores, JOA scores, Frankel grades and spinal sagittal diameter residual rates than before operation, the difference was statistically significant(P<0.05). VAS score, JOA score, neural function according to Frankel classification and sagittal spinal canal diameter residual rate comparison at 6-month follow-up were not statistically different between two groups(P>0.05). At 6 months after operation, three dimensional reconstruction of CT showed 100% bone healing rate of two groups, and there was no significant difference between two groups(P>0.05). Dynamic X-ray showed good stability. There were no screw breakage and loosening, no significant loss of intervertebral height and no cage subsidence. Conclusions: The short term effect of the posterior lateral approach spinal decompression and interbody fusion for thoracic intervertebral disc herniation is satisfactory.