====== Thoracic disc herniation surgery ======

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[[Thoracic disc herniation surgery]] can be challenging due to the anatomical constraints and the high risk of morbidity due to proximity to the thoracic spinal cord. Moreover, the selection of an appropriate surgical approach depends on various factors such as the size and location of disc herniation within the spinal canal, spinal level, presence or absence of calcification, degree of spinal cord compression, and familiarity with various approaches by the treating surgeon. While there is agreement that posterolateral approaches can be used to treat posterolateral and central soft disc herniation, there is a lack of consensus on the best surgical approach for central calcified and giant calcified TDH where an anterior approach is perceived as the best option. There is increasing evidence that supports the safety and efficacy of posterolateral approaches even for central calcified and giant calcified TDH
((Kasliwal MK. Evolution and current status of surgical management of thoracic disc herniation - A review. Clin Neurol Neurosurg. 2023 Nov 19;236:108055. doi: 10.1016/j.clineuro.2023.108055. Epub ahead of print. PMID: 37992532.))

===== Thoracic discectomy =====

see [[Thoracic discectomy]]. 

Intraoperative SSEPs and MEPs may be helpful for patients with myelopathy.
For a laterally located herniated noncalcified thoracic disc posterolateral
approach with medial facetectomy is technically simple and has generally good results. For a central disc herniation, or when myelopathy is present: the transthoracic approach has the lowest incidence of cord injury with the best operative results 


===== Indications =====

Thoracic disc herniation requiring surgery are rare
((Experience in the surgical management of 82
symptomatic herniated thoracic discs and review
of the literature. J Neurosurg. 1998; 88:623–633))

Indications: refractory pain (usually radicular, bandlike) or progressive myelopathy. Uncommon: symptomatic syringomyelia originating at level of disc herniation.

===== Approaches =====

see [[Thoracic spine approaches]].