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Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and
Richard Bransford1, Fangyi Zhang, Carlo Bellabarba
1Department of Orthopedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA. rbransfo@u.washington.edu
Journal of Neurosurgery. Spine
|February 4, 2010
Summary
This study shows a posterior transfacet pedicle-sparing approach is a safe option for thoracic disc herniations (TDH), improving patient symptoms. While some complications occurred, all patients experienced symptom relief after this surgical technique.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Orthopedic Surgery
Background:
- Symptomatic thoracic disc herniations (TDHs) are uncommon, often treated with anterior approaches.
- Posterior approaches exist, but transthoracic decompression remains the gold standard.
- Anterior approaches may not suit all patients due to comorbidities or herniation characteristics.
Purpose of the Study:
- To evaluate outcomes and complications of a posterior transfacet pedicle-sparing approach for TDH.
- To assess the safety and efficacy of this technique in a consecutive patient series.
- To compare outcomes with traditional anterior approaches for specific TDH subtypes.
Main Methods:
- Retrospective review of 18 consecutive patients with TDH undergoing transfacet pedicle-sparing decompression, discectomy, and posterior instrumentation/fusion.
- Assessment of clinical records for pre- and postoperative motor scores, Nurick grades, and visual analog pain scale (VAS) scores.
- Review of imaging studies to evaluate herniation characteristics, alignment, and instrumentation accuracy; complication assessment.
Main Results:
- All 29 TDHs (T1-2 to T12-L1) were successfully decompressed without wrong-level surgery or CSF leak.
- Mean Nurick grade improved from 2.5 to 1.9; mean VAS score improved from 59 to 21.
- Twelve patients had no complications; 5 developed infections/seromas, 1 had instrumentation revision, and 1 experienced transient neurological deterioration with fracture.
Conclusions:
- A modified transfacetal pedicle-sparing approach with short segmental fusion is a viable option for specific TDH subtypes.
- This technique allows for concurrent decompression and stabilization.
- Despite a 33% complication rate requiring further surgery, all patients showed improvement from their preoperative status.
