Gregory M Malham1, Rhiannon M Parker2. 1. Neuroscience Institute, Epworth Hospital, Melbourne, Victoria 3121, Australia ; 2. Greg Malham Neurosurgeon, Melbourne, Victoria 3004, Australia.
Abstract
BACKGROUND: Symptomatic thoracic herniated discs have historically been treated using open exposures (i.e., thoracotomy), posing a clinical challenge given the approach related morbidity. Lateral interbody fusion (LIF) is one modern minimally disruptive alternative to thoracotomy. The direct lateral technique for lumbar pathologies has seen a sharp increase in procedural numbers; however application of this technique in thoracic pathologies has not been widely reported. METHODS: This study presents the results of three cases where LIF was used to treat symptomatic thoracic disc herniations. Indications for surgery included thoracic myelopathy, radiculopathy and discogenic pain. Patients were treated with LIF, without supplemental internal fixation, and followed for 24 months postoperatively. RESULTS: Average length of hospital stay was 5 days. One patient experienced mild persistent neuropathic thoracic pain, which was managed medically. At 3 months postoperative all patients had returned to work and by 12 months all patients were fused. From preoperative to 24-month follow-up there were mean improvements of 83.3% in visual analogue scale (VAS), 75.3% in Oswestry Disability Index (ODI), and 79.2% and 17.4% in SF-36 physical (PCS) and mental component scores (MCS), respectively. CONCLUSIONS: LIF is a viable minimally invasive alternative to conventional approaches in treating symptomatic thoracic pathology without an access surgeon, rib resection, or lung deflation.
BACKGROUND: Symptomatic thoracic herniated discs have historically been treated using open exposures (i.e., thoracotomy), posing a clinical challenge given the approach related morbidity. Lateral interbody fusion (LIF) is one modern minimally disruptive alternative to thoracotomy. The direct lateral technique for lumbar pathologies has seen a sharp increase in procedural numbers; however application of this technique in thoracic pathologies has not been widely reported. METHODS: This study presents the results of three cases where LIF was used to treat symptomatic thoracic disc herniations. Indications for surgery included thoracic myelopathy, radiculopathy and discogenic pain. Patients were treated with LIF, without supplemental internal fixation, and followed for 24 months postoperatively. RESULTS: Average length of hospital stay was 5 days. One patient experienced mild persistent neuropathic thoracic pain, which was managed medically. At 3 months postoperative all patients had returned to work and by 12 months all patients were fused. From preoperative to 24-month follow-up there were mean improvements of 83.3% in visual analogue scale (VAS), 75.3% in Oswestry Disability Index (ODI), and 79.2% and 17.4% in SF-36 physical (PCS) and mental component scores (MCS), respectively. CONCLUSIONS: LIF is a viable minimally invasive alternative to conventional approaches in treating symptomatic thoracic pathology without an access surgeon, rib resection, or lung deflation.
Authors: K B Wood; J M Blair; D M Aepple; M J Schendel; T A Garvey; C R Gundry; K B Heithoff Journal: Spine (Phila Pa 1976) Date: 1997-03-01 Impact factor: 3.468
Authors: Larry T Khoo; Zachary A Smith; Farbod Asgarzadie; Yorgios Barlas; Sean S Armin; Vartan Tashjian; Baron Zarate Journal: J Neurosurg Spine Date: 2011-01-07
Authors: P C McAfee; J R Regan; T Zdeblick; J Zuckerman; G D Picetti; S Heim; W P Geis; I L Fedder Journal: Spine (Phila Pa 1976) Date: 1995-07-15 Impact factor: 3.468