Differential operative therapy of thoracic disc herniation. Experiences with 26 cases

Thoracic disc herniation still is a rather rare disease in patients being referred to a non-specialized neurosurgical unit. According to the records from 1985 till June 1996 26 patients (15 male and 11 female) were treated for this reason in our department. The age rage was from 21 to 75 years. In young people there usually was a history of trauma, e.g. associated with sports, and the upper third of the thoracic spine was affected. Patients presented with varying degrees of neurological deficits, ranging from radicular pain to Brown-Sequard-syndrome and severe paraparesis. Diagnosis was usually confirmed by MRI. The majority of our group (14 patients) was treated by a dorsal approach (transpedicular-transfacetal, combined with hemi-laminectomy). Two patients underwent thoracotomy and 10 had costotransversectomy (dorso-lateral approach). Two patients had to be reoperated, both via the original route - by thoracotomy and costotransversectomy. Otherwise there were no serious complications. Three patients reported only a slight, all others a marked relief of their symptoms. The outcome in terms of rapid relief of neurological impairment depended on the age of the patients and the quality of the herniation (removal of sequestrated disc material had a better chance than drilling away of osteochondrosis). Costotransversectomy was more often applied during the last years and seems to yield the best results. Especially in the mid-thoracic portion where the spinal canal is narrow and any shift of the cord has to be avoided costotransversectomy is mandatory and done with less hazards than thoracotomy.