[Transthoracic approach and costotransversectomy in thoracic discogenic disease]

The thoracic discogenic disease is the rarest, yet is most devastating of all disc lesions. The clinical manifestations including myelopathy and radiculopathy are not characteristic, therefore accurate radiological diagnosis has to be made by carefully performed myelography and CT, and recently by MRI. Historically conventional laminectomy has been attended with terrible results such as paraplegia. Therefore transthoracic approach and costo-transversectomy have been the procedure of choice in recent years, and these procedures can be performed safely and effectively without serious complications with help of the operating microscope. Transthoracic approach is a more decisive anterolateral operation for the central disc and the spondylotic spur in the midthoracic spine with excellent visualization of the anterior aspect of the spinal cord. On the other hand, costrotransversectomy is a less formidable posterolateral approach and it provides a reasonable exposure to the lateral disc and the enlarged facet in the lower thoracic spine. The details of the both operative procedures were discussed by using illustrations.