Recent advances in the surgical management of herniated thoracic discs

Symptomatic thoracic disc herniation is an uncommon entity, without characteristic clinical presentation, and remains a surgical challenge. The initial surgical procedure for thoracic disc herniations was laminectomy with discectomy. The high rate of post-operative neurological deficit makes laminectomy now unacceptable for thoracic disc herniation treatment. Transthoracic, transpedicular, and posterolateral (costotransversectomy) approaches of thoracic discectomy have been used successfully. This review comprises eight papers. Six of them report retrospective series of patients with symptomatic thoracic disc herniations treated by the transpedicular approach (Le Roux, 20 patients), the transfacet pediclesparing approach (Stillermann, 6 patients; Ridenour, 12 patients), modified costotransversectomy (Simpson, 21 patients; Ridenour, 15 patients), the lateral extracavitary approach (Delfini, 20 patients), and the anterior cervical approach (Rossiti, 1 patient with T1-T2 disc). Comparison of the results of the posterolateral and anterolateral approaches does not show clear evidence of better neurological results or pain relief with one type of approach rather than another. Endoscopic or video-assisted techniques have been used recently (Rosenthal, 1 patient; Hae-Dong Jho, 2 patients) and seem attractive.