Surgical Management of Thoracic Disc Herniation: Anterior vs Posterior Approach

Özet

AIM: To compare outcomes and complications in patients with thoracic disc herniation (TDH) undergoing surgery with either theposterior or anterior approach.MATERIAL and METHODS: A total of 86 patients, with 98 symptomatic TDHs, who underwent surgery in a single institutionbetween 2007 and 2016, were included. Overall, 68 patients were in the anterior and 18 were in the posterior group. Ten patientsunderwent multilevel TDH surgery.RESULTS: The groups were similar in age, sex, body mass index, and clinical symptoms. In the anterior group, 4 patients (5.9%) hadmajor complications, and 26 (38.2%) had minor complications. In the posterior group, 6 patients (33.3%) had major complications,and 4 (22.2%) had minor complications. Visual analog scores at the final follow-up improved in both groups as compared tobaseline preoperative scores (p>0.05). The rate of neurological improvement in patients with myelopathy was significantly higher inthe anterior group (43/50) than in the posterior group (8/14) (p<0.05).CONCLUSION: The current study showed that higher rates of major complications in central and calcified paracentral TDHsare associated with posterior approaches when compared to anterior approaches. In addition, anterior approaches had superiorneurological recovery and clinical outcomes. Therefore, we recommend the anterior approach for the treatment of calcified and/ornon-calcified central and calcified paracentral TDH, while reserving posterior approaches for small non-calcified paracentral discherniations.