Spinal cord compression due to thoracic disc herniation: results of microsurgical posterolateral costotransversectomy

Fifteen consecutive patients with thoracic disc herniation treated by posterolateral microsurgical costotransversectomy are described. With appropriate modifications to the standard technique, costotransversectomy was found to be a suitable approach even for calcified central discs, and discs which had eroded intradurally. All patients had evidence of spinal cord compression preoperatively with varying degrees of leg weakness. The results of surgery are discussed. Ten patients who were disabled but ambulant showed marked improvement in symptoms and signs. Of the remaining five, all of whom were severely disabled and nonambulant preoperatively, four demonstrated significant improvement. Most patients mobilised rapidly, 13 being able to walk unaided within 24 hours. One patient developed an intrathoracic meningocoele postoperatively, which resolved after multiple percutaneous aspirations. Otherwise there were no serious pulmonary complications. We believe that costotransversectomy is the approach of choice for central as well as centrolateral and lateral thoracic disc herniations.