Surgical management of thoracic disc herniation by costotransversectomy combined with laminectomy

Moawad, ِAhmed Mohamed; Elsawy, Medhat Mmtaz

doi:10.21608/bmfj.2022.131011.1576

Surgical management of thoracic disc herniation by costotransversectomy combined with laminectomy

Document Type : Original Article

Authors

¹ neurosurgery unit , department of surgery , faculty of medicine , Minia university. Minia city , Minia , Egypt

² neurosurgery unit, Department of surgery, faculty of medicine, Minia university Minia city , Minia , Egypt

10.21608/bmfj.2022.131011.1576

Abstract

Background: patients with symptomatic herniated thoracic discs may require operation for intractable radiculopathy or functionally disabling myelopathy. In the past, laminectomy was the procedure of choice for the treatment of thoracic herniations, but due to high rate of neurological morbidity, several strategies have been developed to excise the disc without manipulating the spinal cord.
Aim: The focus of this paper is evaluating costotransversectomy approach in treatment of thoracic disc herniations.
Patient and Methods: twelve patients presenting with herniated thoracic disc in whom surgery was performed via a costotransversectomy approach combined with laminectomy between year 2017 and year 2021 in neurosurgical department, Minia university are reviewed. Eight patients presented with myelopathy and four patients with myeloradiculopathy. Radiological diagnosis was accomplished by magnetic resonance imaging.
Results: Eighty percent of the discs were contralateral while twenty were lateral. Evidence of calcifications was present in eighty percent of patients. No major intraoperative complications were observed. The outcome of surgery was excellent in 66.7%, good in 16.7%, fair in 8.3% and poor in 8.3%. Of those with myelopathy, ten regained ambulation and seven regained normal bladder function. No patients with myelopathy experienced neurological worsening. Regarding radiculopathy, 3 patients had postoperative pain relief while in one, it remained unchanged. No patients suffered postoperative spinal instability-related pain or delayed kyphosis.
Conclusions: The costotransversectomy approach is most applicable to lateral or contralateral calcified or soft discs. The more anterior (transthoracic or thoracoscopic) approaches may be more useful for excision of central calcified discs.

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