Transcostovertebral approach for thoracic disc herniations

Object. The authors describe a new posterolateral transcostovertebral appro ach for the removal of herniated thoracic discs. Methods. From January 1994 to January 2000, 28 thoracic discs in 22 patient s were excised via a new transcostovertebral surgical approach. Seventeen p atients (77%) presented with axial pain, 14 (64%) with radicular pain, 13 ( 59%) with myelopathy, eight (36%) with sensory loss, and 10 (45%) with geni tourinary (GU) symptoms such as urinary hesitancy or incontinence. The affe cted discs were approached using a midline incision to gain access of the c ostovertebral junction. The surgical corridor was posterolateral; the costo vertebral joint and lateral edge of the vertebral endplates were drilled to expose the lateral annulus. The ribs were preserved, obviating the need fo r insertion of a chest tube postoperatively. The average operating time per level was 200.5 minutes (range 90-360 minute s). The average blood loss was 231 mi (50-750 mi). The average length of st ay was 3.8 days. Most patients were discharged home on postoperative Day 2 or 3. No patients were worse postoperatively. improvement was demonstrated in 13 (76%) of 17 patients with axial pain, II (79%) of 14 patients with ra dicular pain, 11 (85%) of 13 patients with myelopathy, seven (88%) of eight patients with sensory loss, and six (60%) of 10 patients with GU symptoms. Conclusions. This procedure is well suited for any thoracic disc lever and offers several advantages over the traditional costotransversectomy or tran sthoracic approaches: shorter operating time, less blood loss, less extensi ve soft-tissue and bone dissection, reduced postoperative pain, and shorter hospital stays.