Thoracic Discectomy

What is it?

Thoracic Discectomy is a surgical procedure to remove herniated or degenerated discs from the thoracic spine. While less common than cervical or lumbar disc herniations, thoracic disc pathologies can cause significant pain, myelopathy, or radiculopathy. Indications for thoracic discectomy typically include symptomatic disc herniations that are refractory to conservative treatment, especially those causing neural compression. The primary goal of thoracic discectomy is to relieve pain and neurological symptoms.

The thoracic spine’s unique anatomy presents distinct challenges for discectomy procedures. The presence of the rib cage, the relative inaccessibility of the thoracic discs, and the proximity of the spinal cord and thoracic organs make surgical access more complex than in the cervical or lumbar regions. Additionally, the smaller size of the spinal canal in the thoracic region increases the risk of spinal cord injury during surgery.

Procedure

Several surgical approaches can be used for thoracic discectomy, each with its advantages and limitations:

 

  • Posterior or Posterolateral Approaches: These are commonly used for laterally located or foraminal herniations. Techniques may involve a laminectomy or costotransversectomy (surgical approach via posterolateral window removing a portion of the rib) to access the disc. These approaches, however, may not provide adequate access for centrally located herniations.

 

  • Anterior Approaches: The transthoracic or retroperitoneal approach provides direct access to the thoracic discs, especially for centrally located herniations. This approach, however, involves more extensive dissection.

 

  • Thoracoscopic Approaches: Minimally invasive thoracoscopic techniques offer the advantage of reduced postoperative pain and quicker recovery. These are particularly useful for smaller, centrally located herniations.

 

Given the proximity to the spinal cord, meticulous surgical technique is crucial. Intraoperative neuromonitoring is often used to monitor spinal cord function throughout the procedure.