Background: The choice between transthoracic, lateral, and posterolateral approaches to excise thoracic disc herniations remains controversial.
Methods: The outcome of the three approaches was compared in seven of the authors' cases and in 324 other cases reported in the literature.
Results: Partial or total neurological recovery was found in 93% after a transthoracic procedure versus 87% after a posterolateral technique and 80% after a lateral approach (P < 0.05). A trend toward superior results after a transthoracic technique was also noted in subgroups of patients with radiculopathy, patients with intradural disc herniations, and patients with multiple lesions, although statistical significance was not reached. Pulmonary complications occurred in 7% of transthoracic techniques versus 5% in lateral and 0% in posterolateral techniques (p < 0.025).
Conclusions: The transthoracic approach is recommended for all thoracic disc herniations below the T4 level except for patients with serious pulmonary compromise.