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Indications and Techniques for Spinal Instrumentation in Thoracic Disk Surgery.

Mark E Oppenlander¹, Justin C Clark, James Kalyvas

¹Department of Neurological Surgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ.

Clinical Spine Surgery

|February 19, 2016

Summary

Instrumented fusion during thoracic discectomy is safe and effective for select patients, particularly those with myelopathy or complex herniated discs. While associated with increased blood loss and complications, it prevents delayed instability, unlike non-instrumented procedures.

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Area of Science:

Neurosurgery
Spinal Surgery
Orthopedic Surgery

Background:

Thoracic discectomy involves extensive bone removal, potentially risking spinal cord manipulation.
Indications and techniques for instrumented fusion in thoracic discectomy are not well-defined.

Purpose of the Study:

To identify indications, techniques, and outcomes of instrumented fusion during thoracic discectomy.
Compare outcomes between instrumented and non-instrumented thoracic discectomy.

Main Methods:

Retrospective case series of 220 patients undergoing thoracic discectomy (1992-2012).
Compared clinical and radiographic variables between instrumented and non-instrumented groups.
Analyzed outcomes based on surgical approach.

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Main Results:

Instrumented fusion was associated with myelopathy and complex herniated discs (giant, calcified, transdural).
Instrumented fusion led to increased blood loss, longer hospital stays, and higher complication rates (22% vs. 9.9%).
Both groups achieved similar symptom resolution; however, 2.1% of non-instrumented cases developed delayed instability requiring fusion.

Conclusions:

Thoracic discectomy without fixation is viable for carefully selected patients.
Instrumented fusion is safe and effective for specific patient groups.
Proposed indications for fixation and fusion in thoracic discectomy.