Turkish Neurosurgery
SURGICAL MANAGEMENT OF THORACIC DISC HERNIATION: ANTERIOR VS POSTERIOR APPROACH
Ismail Oltulu1, Hemra Cil2, Sigurd Berven3, Dean Chou4, Aaron Clark4, Mustafa Onur Ulu5, Christopher Ames4, Vedat Deviren3
1VM Medical Park Pendik Hospital, Orthopeadics and Traumatology, İstanbul,
2University of California, San Francisco, USA, Anesthesia and Reanimation, San Francisco,
3University of California, San Francisco, USA, Orthopeadics and Traumatology, San Francisco,
4University of California, San Francisco, USA, Neurosurgery, San Francisco,
5Cerrahpasa Medical Faculty, Istanbul University, Neurosurgery, Istanbul,
DOI: 10.5137/1019-5149.JTN.24969-18.2
Aim:We aimed to compare outcomes and complications in patients with thoracic disc herniation (TDH) undergoing surgery with either the posterior or anterior approach. Material and Methods:86 patients, with a total of 98 symptomatic TDHs, who underwent surgery in a single institution between 2007 and 2016, were included. Overall, 68 patients were in the anterior and 18 were in the posterior group. Ten patients underwent multilevel TDH surgery. Results:The groups were similar in age, sex, body mass index, and clinical symptoms. In the anterior group, 4 patients (5.9%) had major complications, and 26 (38.2%) had minor complications. In the posterior group, 6 patients (33.3%) had major complications, and 4 (22.2%) had minor complications. Visual analog scores at the final follow-up improved in both groups as compared to baseline preoperative scores (p > 0.05). The rate of neurological improvement in patients with myelopathy was significantly higher in the anterior group (43/50) than in the posterior group (8/14) (p < 0.05). Conclusion:The current study showed that higher rates of major complications in central and calcified paracentral TDH are associated with posterior approaches when compared to anterior approaches. In addition, anterior approaches had superior neurological recovery and clinical outcomes. Therefore, we recommend the anterior approach for the treatment of calcified and/or non-calcified central and calcified paracentral TDH, while reserving posterior approaches for small non-calcified paracentral disc herniations.
Corresponding author : Ismail Oltulu