T3-T4 Disc Herniations: Clinical Presentation, Imaging, and Transaxillary Approach

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Surgery

Background:

• Thoracic disc herniations (TDHs) are uncommon spinal pathologies.
• T3-T4 TDHs present unique diagnostic and surgical challenges due to their location and potential for misdiagnosis as cervical issues.
• The thoracoscopic transaxillary approach (TAA) offers a minimally invasive option for accessing the upper thoracic spine.

Purpose of the Study:

• To describe the clinical and radiologic characteristics of T3-T4 TDHs.
• To evaluate the efficacy and safety of the thoracoscopic transaxillary approach (TAA) for T3-T4 TDHs.
• To highlight the unique anatomical considerations for TAA in the upper thoracic region.

Main Methods:

• Retrospective review of patients operated on for T3-T4 TDH with a minimum 1-year follow-up.
• Surgical technique involved a thoracoscopic transaxillary approach (TAA) with a 10-mm 30° rigid high-definition scope.
• Assistance from a cardiothoracic surgeon was utilized for optimal exposure.

Main Results:

• Eight TAA procedures for T3-T4 TDH were analyzed.
• Most patients presented with axial pain and sensory changes; motor weakness was less common.
• The TAA demonstrated a good outcome with symptomatic relief in 7 of 8 patients, with no major complications.

Conclusions:

• T3-T4 TDHs are infrequent and may be underdiagnosed, often mimicking cervical spine problems.
• The thoracoscopic transaxillary approach (TAA) is a safe, effective, and well-tolerated method for treating T3-T4 TDHs.
• Careful dissection and knowledge of upper thoracic anatomy, with cardiothoracic surgical assistance, are crucial for successful TAA outcomes.