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Perspective: Transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy

BACKGROUND: Anterior transthoracic, posterolateral (i.e., costotransversectomy/lateral extracavitary), and transpedicular approaches are now utilized to address anterior, anterolateral, or lateral thoracic disk herniations (TDH). Notably, laminectomy has not been a viable option for treating TDH for...

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Autores principales: Epstein, Nancy E, Abulnick, Marc A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10481820/
https://www.ncbi.nlm.nih.gov/pubmed/37680932
http://dx.doi.org/10.25259/SNI_648_2023
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author Epstein, Nancy E
Abulnick, Marc A
author_facet Epstein, Nancy E
Abulnick, Marc A
author_sort Epstein, Nancy E
collection PubMed
description BACKGROUND: Anterior transthoracic, posterolateral (i.e., costotransversectomy/lateral extracavitary), and transpedicular approaches are now utilized to address anterior, anterolateral, or lateral thoracic disk herniations (TDH). Notably, laminectomy has not been a viable option for treating TDH for decades due to the much lower rate of acceptable outcomes (i.e., 57% for decompressive laminectomy vs. over 80% for the posterolateral, lateral, and transthoracic procedures), and a higher risk of neurological morbidity/paralysis. METHODS: Patients with TDH averaged 48-56.3 years of age, and presented with pain (76%), myelopathy (61%-99%), radiculopathy (30%-33%), and/or sphincter loss (16.7%-24%). Those with anterior/anterolateral TDH (30-74%) were usually myelopathic while those with more lateral disease (50-70%) exhibited radiculopathy. Magnetic resonance (MR) studies best defined soft-tissue/disk/cord pathology, CAT scan (CT)/Myelo-CT studies identified attendant discal calcification (i.e. fully calcified 38.9% -65% vs. partial calcification 27.8%), while both exams documented giant TDH filling > 30 to 40% of the canal (i.e., in 43% to 77% of cases). RESULTS: Surgical options for anterior/anterolateral TDH largely included transthoracic or posterolateral approaches (i.e. costotransversectomy, lateral extracavitary procedures) with the occasional use of transfacet/transpedicular procedures mostly applied to lateral disks. Notably, patients undergoing transthoracic, lateral extracavitary/costotransversectomy/ transpedicular approaches may additionally warrant fusions. Good/excellent outcomes were quoted in from 45.5% to 87% of different series, with early postoperative adverse events reported in from 14 to 14.6% of patients. CONCLUSION: Anterior/anterolateral TDH are largely addressed with transthoracic or posterolateral procedures (i.e. costotransversectomy/extracavitary), with a subset also utilizing transfacet/transpedicular approaches typically adopted for lateral TDH. Laminectomy is essentially no longer considered a viable option for treating TDH.
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spelling pubmed-104818202023-09-07 Perspective: Transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy Epstein, Nancy E Abulnick, Marc A Surg Neurol Int Review Article BACKGROUND: Anterior transthoracic, posterolateral (i.e., costotransversectomy/lateral extracavitary), and transpedicular approaches are now utilized to address anterior, anterolateral, or lateral thoracic disk herniations (TDH). Notably, laminectomy has not been a viable option for treating TDH for decades due to the much lower rate of acceptable outcomes (i.e., 57% for decompressive laminectomy vs. over 80% for the posterolateral, lateral, and transthoracic procedures), and a higher risk of neurological morbidity/paralysis. METHODS: Patients with TDH averaged 48-56.3 years of age, and presented with pain (76%), myelopathy (61%-99%), radiculopathy (30%-33%), and/or sphincter loss (16.7%-24%). Those with anterior/anterolateral TDH (30-74%) were usually myelopathic while those with more lateral disease (50-70%) exhibited radiculopathy. Magnetic resonance (MR) studies best defined soft-tissue/disk/cord pathology, CAT scan (CT)/Myelo-CT studies identified attendant discal calcification (i.e. fully calcified 38.9% -65% vs. partial calcification 27.8%), while both exams documented giant TDH filling > 30 to 40% of the canal (i.e., in 43% to 77% of cases). RESULTS: Surgical options for anterior/anterolateral TDH largely included transthoracic or posterolateral approaches (i.e. costotransversectomy, lateral extracavitary procedures) with the occasional use of transfacet/transpedicular procedures mostly applied to lateral disks. Notably, patients undergoing transthoracic, lateral extracavitary/costotransversectomy/ transpedicular approaches may additionally warrant fusions. Good/excellent outcomes were quoted in from 45.5% to 87% of different series, with early postoperative adverse events reported in from 14 to 14.6% of patients. CONCLUSION: Anterior/anterolateral TDH are largely addressed with transthoracic or posterolateral procedures (i.e. costotransversectomy/extracavitary), with a subset also utilizing transfacet/transpedicular approaches typically adopted for lateral TDH. Laminectomy is essentially no longer considered a viable option for treating TDH. Scientific Scholar 2023-08-25 /pmc/articles/PMC10481820/ /pubmed/37680932 http://dx.doi.org/10.25259/SNI_648_2023 Text en Copyright: © 2023 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Review Article
Epstein, Nancy E
Abulnick, Marc A
Perspective: Transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy
title Perspective: Transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy
title_full Perspective: Transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy
title_fullStr Perspective: Transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy
title_full_unstemmed Perspective: Transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy
title_short Perspective: Transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy
title_sort perspective: transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10481820/
https://www.ncbi.nlm.nih.gov/pubmed/37680932
http://dx.doi.org/10.25259/SNI_648_2023
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