THORACIC DISC HERNIATIONS - TRANSTHORACIC, LATERAL, OR POSTEROLATERALAPPROACH - A REVIEW

BACKGROUND The choice between transthoracic, lateral, and posterolater al approaches to excise thoracic disc herniations remains controversia l. METHODS The outcome of the three approaches was compared in seven o f the authors' cases and in 324 other cases reported in the literature . RESULTS Partial or total neurological recovery was found in 93% afte r a transthoracic procedure versus 87% after a posterolateral techniqu e and 80% after a lateral approach (p < 0.05). A trend toward superior results after a transthoracic technique was also noted in subgroups o f patients with radiculopathy, patients with intradural disc herniatio ns, and patients with multiple lesions, although statistical significa nce was not reached. Pulmonary complications occurred in 7% of transth oracic techniques versus 5% in lateral and 0% in posterolateral techni ques (p < 0.025). CONCLUSIONS The transthoracic approach is recommende d for all thoracic disc herniations below the T4 level except for pati ents with serious pulmonary compromise. (C) 1998 by Elsevier Science I nc.