THORACIC DISC DISEASE - EXPERIENCE WITH THE TRANSPEDICULAR APPROACH IN 20 CONSECUTIVE PATIENTS

TWENTY CONSECUTIVE PATIENTS were treated for symptomatic thoracic disc herniation with the transpedicular approach. Most patients had severe , incapacitating local or radicular pain. Myelopathy was uncommon as m agnetic resonance imaging allowed an early diagnosis. Computed tomogra phy, after myelography, provided further information necessary for sur gical planning. Three patients had disc disease at two levels. Nine ce ntral and 14 lateral disc herniations were found. Disc calcification o r an associated osteophyte was identified in six instances. Although t he size of the disc herniation correlated with the amount of cord comp ression, no radiological features were found to be correlated with neu rological function. The transpedicular approach was used in all patien ts. New curettes, specifically designed for the procedure, allowed the removal of all discs, including central and calcified fragments. A mo dified arthroscope was used to confirm neural decompression in some in stances. One year after surgery, all 20 patients were significantly im proved and 8 patients were asymptomatic. Apart from the duration of th e symptoms, no other factors were found to affect outcome. The finding s suggest that the prognosis of thoracic disc herniation is excellent if the disease is recognized early. The transpedicular approach, using curettes specifically designed for the procedure, can be an effective and safe method of surgical decompression in carefully selected patie nts.