Microsurgical Experience with Pedicle-Sparing Transfacet Approach for Thoracic Disk Herniation

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Spine Surgery

Background:

• Thoracic disk herniation (TDH) is uncommon, and traditional posterior surgical approaches carry significant risks.
• Existing surgical methods for TDH, such as thoracotomy or thoracoscopy, are often cumbersome and associated with high morbidity.
• There is a need for simplified, familiar, and less morbid surgical techniques for TDH.

Purpose of the Study:

• To evaluate the feasibility and clinical outcomes of the pedicle-sparing transfacet approach (PSTA) for thoracic disk herniation (TDH) under microscopic visualization.
• To assess complication and morbidity rates associated with the PSTA in a cumulative clinical series.
• To determine if the PSTA provides a safe and effective alternative to existing surgical methods for TDH.

Main Methods:

• A consecutive series of 28 patients with TDH, unresponsive to conservative treatment, underwent PSTA.
• Surgical procedures were performed by a senior neurosurgeon using microscopic visualization.
• Preoperative and postoperative clinical assessments included lower extremity strength, sensation, reflexes, Visual Analog Scale (VAS) scores, and Nurick grades. Postoperative MRI and complication monitoring were conducted.

Main Results:

• The PSTA was successfully performed in 28 patients, with disk levels ranging from T8 to T12-L1.
• Postoperative MRI confirmed satisfactory herniation removal in all but one patient.
• Significant improvements were observed in median VAS scores (7.4 to 2.3) and Nurick grades (2.7 to 1.6), with no reported infections, wrong-level surgeries, or incidental durotomies.

Conclusions:

• The microsurgical PSTA is a safe and feasible technique for treating thoracic disk herniation (TDH).
• The approach provides a wide surgical window, facilitating satisfactory decompression, and does not require segmental instrumentation postoperatively.
• The PSTA is associated with a significantly shorter learning curve for surgeons compared to other TDH surgical techniques.