Thoracic disc herniation: Case series and protocol for surgical approaches

Abstract

Objective: To describe the surgical results of a prospective series of five patients operated according to an approach indication protocol. Methods: Patients were classified according to surgical risk: Group A (high risk) or B (low risk) and subsequently into subgroups according to characteristics of the herniation and ultimately the surgical approach was defined: A.1) calcified central herniations - thoracoscopy; A.2) soft lateral herniations - posterolateral approach; A.3) centrolateral herniations - partial calcification in lateral position - posterolateral approach; higher density central calcification - thoracoscopy; B.1) central or centrolateral calcified herniations - thoracotomy or thoracoscopy; B.2) soft lateral herniations - posterolateral approach. Results: The duration of symptoms ranged from 2 months to 3 years; the age bracket was from 37 to 58 years; sex distribution was 3 female and 2 male patients and the length of hospital stay ranged from 2 to 20 days. The most affected level was T11/12. A patient classified as Group A.3 underwent posterolateral approach. The remaining patients were Group B.1, 3 submitted to thoracotomy and 1 to thoracoscopy. The herniation removal was completed in 5 cases; 3 patients improved and 2 remained stable. The morbidity and the recovery time were higher in patients who underwent anterolateral approaches. Conclusions: Classify patients according to surgical risk and the anatomical characteristics of disc herniation allows for complete decompression, minimizing morbidity and mortality.