Our Summary

This research paper is a review of previous studies that have examined the outcomes of two different surgical approaches to treating thoracic disc herniations - a condition where the discs in the spine become damaged, often causing pain and nerve problems. The two approaches are from the front (anterior) and from the back (posterior) of the body.

The researchers looked at 37 different studies, involving over 1,000 patients, and compared the results of the two methods. They found that there was no significant difference in terms of how much the patients’ neurological health improved or worsened with either approach.

However, they did find that there was a higher overall rate of complications with the anterior approach, mostly due to minor respiratory problems. This suggests that the posterior approach might be safer, although the best choice of approach may also depend on other factors, such as the surgeon’s personal preference and the patient’s overall health, particularly their heart and lung function.

The strength of the evidence in this review is ranked as level 4, which indicates that it is based on studies that are not the highest quality, but still provide useful information.

FAQs

  1. What are the two different surgical approaches for treating thoracic disc herniations discussed in the research?
  2. Did the research find any significant difference in the neurological health improvement of patients between the two approaches?
  3. According to the research, which surgical approach had a higher overall rate of complications?

Doctor’s Tip

A doctor might tell a patient considering a discectomy that while both anterior and posterior approaches can be effective in treating thoracic disc herniations, the posterior approach may have a lower risk of complications, particularly related to respiratory issues. However, the best approach for each individual patient may depend on various factors, so it is important to discuss all options with your surgeon and consider your overall health before making a decision.

Suitable For

Patients who are typically recommended for discectomy include those who have tried conservative treatments such as physical therapy, medications, and injections but have not experienced significant relief from their symptoms. Patients with severe or progressive neurological deficits, such as weakness, numbness, or tingling in the arms or legs, may also be candidates for discectomy. Additionally, patients who have significant pain that is not responding to other treatments may be recommended for surgery.

It is important for patients considering discectomy to discuss their symptoms, medical history, and treatment options with their healthcare provider to determine if surgery is the best course of action for their specific situation.

Timeline

Before discectomy:

  1. Patient experiences symptoms of thoracic disc herniation, such as back pain, numbness, weakness, or tingling in the arms or legs.
  2. Patient undergoes diagnostic tests, such as MRI or CT scans, to confirm the diagnosis.
  3. Patient may undergo conservative treatments, such as physical therapy or medications, to manage symptoms.
  4. If conservative treatments are not effective, patient and surgeon decide to proceed with discectomy surgery.

After discectomy:

  1. Patient undergoes the discectomy surgery, which can be performed through either an anterior or posterior approach.
  2. Patient is monitored closely in the hospital for a few days post-surgery for any complications.
  3. Patient undergoes physical therapy to regain strength and mobility in the affected area.
  4. Patient experiences a gradual improvement in symptoms over the following weeks and months.
  5. Patient follows up with their surgeon for post-operative care and monitoring.
  6. Patient may need to make lifestyle changes, such as avoiding heavy lifting or high-impact activities, to prevent future disc herniations.

What to Ask Your Doctor

Some questions a patient should ask their doctor about discectomy include:

  1. What are the potential risks and complications associated with both the anterior and posterior approaches to discectomy?
  2. How will my overall health and specific factors, such as my heart and lung function, impact the choice of surgical approach?
  3. What is your experience and success rate with each approach to discectomy?
  4. How long is the recovery time for each approach?
  5. Are there any alternative treatments to consider before opting for surgery?
  6. What can I expect in terms of pain relief and improvement in neurological symptoms after the surgery?
  7. Are there any long-term effects or considerations to keep in mind after undergoing a discectomy?
  8. Will I need physical therapy or other types of rehabilitation after the surgery?
  9. How will the decision between anterior and posterior approach be made, and who will be involved in making that decision?
  10. Are there any specific lifestyle changes or precautions I should take post-surgery to ensure the best possible outcome?

Reference

Authors: Hurley ET, Maye AB, Timlin M, Lyons FG. Journal: Spine (Phila Pa 1976). 2017 Dec 15;42(24):E1437-E1445. doi: 10.1097/BRS.0000000000002202. PMID: 28422798