[Surgical treatment of symptomatic thoracic disk hernia: anterior or posterolateral approach?]

From 1981 to 1994, 16 patients with 18 thoracic disk hernias due to degenerative disease (n = 13), trauma (n = 4) or Scheuermann's disease (n = 1) received surgical treatment. Most were situated from T6 to T12. There were 10 medial hernias and 8 lateral hernias. Symptom duration was a mean 23 months at surgery including spinal pain (n = 13) and spinal syndrome (n = 9). Posterolateral access was used in 13 cases and the anterior route in 2, both requiring a graft. After a follow-up of 5 years 1 month, functional and subjective results were excellent or good in 83% of the cases, acceptable in 6% and poor in 11%. Two failures with the posterolateral route corresponded to one patient with initial trauma-induced paraplegia and another with neurological aggravation after the first laminectomy. In our experience, the posteriolateral route is preferred to allow good visual control even in cases involving several levels. Secondary laminectomy may be performed without risking displacement. The presence of the Adamkiewicz artery on the same side and at the same level dictates use of the anterior route which may soon be replaced by video-assisted thoracoscopy to avoid resection of the rib.