Surgical Management of Patients with Multiple Thoracic Herniated Disks: Analysis of Seven Cases with 18-month Follow-up

Introduction:

Thoracic disk herniation accounts for less than 5% of all herniated disks. Patients harboring multiple thoracic herniated disks can be particularly problematic, due to diagnostic delay and the challenging technical surgical aspects involved in their removal. We report our experience in treating seven patients with 16 thoracic disks.

Methods:

Seven patients (4 females, 3 males, age range 34–39) with 16 symptomatic thoracic disks were operated on at one institution. Five patients had 2 disks and 2 patients had 3 disks. All patients had long–standing myelopathy and/or radiculopathy. The 5 patients with 2 disks each underwent diskectomy only via a modified trans–facet approach. The patients with 3 disks underwent diskectomy as well as posterior fixation and fusion. All patients were followed for a minimum of 18 months, with an average of 39 months follow–up.

Results:

All 7 patients had successful resection of their herniated disks. Four out of the 5 patients who were working returned to work. Six of 7 patients with back or radicular pain had drastic or complete pain resolution. Six of 6 patients who had pre–operative ambulatory difficulty had post–operative gait improvement. Discussion: Complications included one wound infection; this resolved with drainage but this patient had continued pain and did not return to work. Two patients with 3, contiguous herniated disks achieved radiographic fusion at one–year follow–up.

Conclusion:

Surgical management of multiple thoracic herniated disks can be achieved via a posterior approach and with a minimum of morbidity and risk to the patient.