Transforaminal approach in thoracal disc pathologies: transforaminal microdiscectomy technique

Abstract

Objective. Many surgical approaches have been defined and implemented in the last few decades for thoracic disc herniations. The endoscopic foraminal approach in foraminal, lateral, and far lateral disc hernias is a contemporary minimal invasive approach. This study was performed to show that the approach is possible using the microscope without an endoscope, and even the intervention on the discs within the spinal canal is possible by having access through the foramen. Methods. Forty-two cases with disc hernias in the medial of the pedicle were included in this study; surgeries were performed with transforaminal approach and microsurgically. Extraforaminal disc hernias were not included in the study. Access was made through the Kambin triangle, foramen was enlarged, and spinal canal was entered. Results. The procedure took 65 minutes in the average, and the mean bleeding amount was about 100cc. They were mobilized within the same day postoperatively. No complications were seen. Follow-up periods range between 5 and 84 months, and the mean follow-up period is 30.2 months. Conclusion. Transforaminal microdiscectomy is a method that can be performed in any clinic with standard spinal surgery equipment. It does not require additional equipment or high costs.

Figure 1

35-year-old female. Back pain and also in both legs. Progressive weakness in lower extremities. Preoperative VAS was 5. In the neurological examination there was paraparesis in low extremities (Case 1). Preoperative views of the patient revealed a thoracic 4-5 disc herniation.

Figure 2

Early postoperative images of the patient after the performance of right transforaminal approach (Case 1).

Figure 3

36-year-old female. Weakness in lower extremities. Preoperative ASIA was C (Case 5). Preoperative CT and MRI revealed a thoracic 8-9 disc herniation.

Figure 4

Postoperative CT, MRI images of Case 5. View of the incision.

Figure 5

34-year-old female. In the neurological examination there was paraparesis in lower extremities (ASIA C). Cord compression of a thoracic 9-10 disc herniation (Case 10). Preoperative CT and MR images at the left side and postoperative images at the right side.