Circumferential Decompression via a ModifiedCostotransversectomy Approach for the Treatment of Single Level Hard Herniated Disc between T10-L1

• Published in: Orthopaedic surgery 2016-02, Vol.8 (1), p.34-43
• Main Authors: Pei, Bo, Sun, Chao, Xue, Ruoyan, Xue, Yuan, Zhao, Ying, Zong, Ya-qi, Lin, Wei, Wang, Pei
• Format: Article
• Language: English
• Subjects: Circumferential decompression; Clinical; Hard thoracic herniated disc; Modified costotransversectomy approach
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.12223

Objective To describe a novel surgical strategy for circumferentially decompressing the T10–L1 spinal canal when impinged upon by single level hard thoracic herniated disc (HTHD) via a modified costotransversectomy approach. Methods This is a retrospective review of 26 patients (17 men, 9 women; mean age at surgery 48.5 years, range 20–77 years) who had undergone single level HTHD between T10–L1 by circumferential decompression via a modified costotransversectomy approach. The characteristics of the approach are using a posterior midline covered incision, which keeps the paraspinal muscle intact and ensures direct visualization of circumferential spinal cord decompression of single level HTHD between T10–L1. Results The average operative time was 208 ± 36 min (range, 154–300 min), mean blood loss 789 ± 361 mL (range, 300–2000 mL), mean preoperative and postoperative mJOA scores 5.2 ± 1.5 and 9.0 ± 1.3, respectively (t = 19.7, P < 0.05). The rate of recovery of neurological function ranged from 33.3% to 100%. The ASIA grade improved in 24 patients (92.3%) and stabilized (no grade change) in two (7.7%). MRI indicated that the cross‐sectional area of the dural sac at the level of maximum compression increased from 45.0 ± 5.8 mm2 preoperatively to 113.5 ± 6.1 mm2 postoperatively (t = 68.2, P < 0.05). Anterior tibialis muscle strength of the 15 patients with foot drop had a mean recovery rate of 95% at final follow‐up. One patient who resumed work early after the surgery showed a significantly augmented Cobb angle. One patient had transient postoperative cerebrospinal fluid leakage. No patients showed neurological deterioration. Conclusions This procedure achieves sufficient direct visualization for circumferential decompression of the spinal cord via a posterior midline covered costotransversectomy approach with friendly bleeding control and without muscle sacrifice. It is a reasonable alternative treatment option for thoracic myelopathy caused by single level HTHD between T10–L1.