Thoracic Discectomy Through a Unilateral Transpedicular or Costotransversectomy Approach with Intraoperative Ultrasound Guidance

BACKGROUND: The disc location, extent of calcification, limited visualization of the ventral cord, and tenuous blood supply to the thoracic spinal cord pose unique technical challenges when surgically treating thoracic disc herniation. OBJECTIVE: To report our initial experience with a series of cases in which intraoperative ultrasound image guidance was used for thoracic discectomy through a unilateral transpedicular or costotransversectomy approach. METHODS: Five patients (n = 5) underwent a transpedicular approach and five (n = 5) underwent costotransversectomy for thoracic discectomy. Pre-and postoperative clinical records, operative reports, disc location/calcification, and complications were reviewed. RESULTS: There were 6 (n = 6) males and 4 (n = 4) females with an average age of 54 yr (range: 33-74). All patients had symptoms attributable to a single-level of thoracic disc herniation. Discs were classified as central (n = 5) and paracentral (n = 5). Preoperative CT and/or intraoperative visualization demonstrated calcified disc material in 6 (n = 6) patients. Final outcomes data at last follow-up was available for 9 of 10 patients. Eight of these nine patients experienced a return to normal baseline functional status. Postoperative imaging confirmed that no wrong-level surgeries were performed. The mean length of follow-up was 20.4 wk (range 4-48). CONCLUSION: Thoracic discectomy with ultrasound visualization via a unilateral transpedicular or costotransversectomy approach is safe and effective for treatment of central and paracentral calcified disc herniations. This tool improves the safety profile of thoracic discectomy and allows for treatment of thoracic discs through less invasive approaches.