Turkish Neurosurgery 2019 , Vol 29 , Num 4
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, Department of Orthopeadics and Traumatology, Istanbul, Turkey
2University of California, Department of Anesthesia and Reanimation, San Francisco, USA
3University of California, Department of Orthopeadics and Traumatology, San Francisco, USA
4University of California, Department of Neurosurgery, San Francisco, USA
5Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.24969-18.2 AIM: To compare outcomes and complications in patients with thoracic disc herniation (TDH) undergoing surgery with either the posterior or anterior approach.

MATERIAL and METHODS: A total of 86 patients, with 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 TDHs 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. Keywords : Thoracic disc, Herniation, Posterior, Anterior, Calcification

Corresponding author : Ismail OLTULU, ioltulu@hotmail.com