Transthoracic discectomy without interbody fusion

Area of Science:

• Neurosurgery
• Spinal Surgery
• Thoracic Surgery

Background:

• Transthoracic discectomy is a standard procedure for thoracic disk disease.
• Interbody fusion is commonly recommended after transthoracic discectomy.
• The necessity of interbody fusion requires further investigation.

Purpose of the Study:

• To evaluate the safety and efficacy of foregoing interbody fusion after transthoracic discectomy.
• To determine if omitting fusion leads to adverse outcomes such as spinal deformity or new axial pain.
• To assess neurological recovery in patients who did not undergo fusion.

Main Methods:

• Retrospective review of 18 patients undergoing transthoracic discectomy without fusion (1996-2002).
• Patients were assessed for neurological symptoms, axial spine pain, and development of kyphosis/scoliosis.
• Radiographic follow-up was conducted for 16 patients, with a mean duration of 22 months.

Main Results:

• No patients developed new axial spine pain or segmental kyphosis/scoliosis.
• 83% of patients experienced significant neurological improvement; 3 nonambulatory patients regained ambulation.
• Four complications occurred: wound infection, pleural effusion, CSF leak, and intercostal neuralgia.

Conclusions:

• Interbody fusion may not be essential for all patients undergoing transthoracic discectomy.
• Omitting fusion appears safe in the short-term, without causing spinal deformity or new axial pain.
• Long-term monitoring is necessary to rule out late-onset spinal instability or deformity.