Open AccessCircumferential Decompression via a ModifiedCostotransversectomy Approach for the Treatment of Single Level Hard Herniated Disc between T 10 –L 1
Author(s) -
Pei Bo,
Sun Chao,
Xue Ruoyan,
Xue Yuan,
Zhao Ying,
Zong Yaqi,
Lin Wei,
Wang Pei
Publication year - 2016
Publication title -
orthopaedic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.666
H-Index - 23
eISSN - 1757-7861
pISSN - 1757-7853
DOI - 10.1111/os.12223
Subject(s) - medicine , decompression , surgery , spinal canal , nuclear medicine , spinal cord , psychiatry
Objective To describe a novel surgical strategy for circumferentially decompressing the T 10 –L 1 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 T 10 –L 1 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 T 10 –L 1 . 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 mm 2 preoperatively to 113.5 ± 6.1 mm 2 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 T 10 –L 1 .