目的:比较胸椎钙化性突出症(cTDH)的手术治疗方法(CTV)和经椎弓根(TP)的方法,在手术和临床结果方面。
背景:cTDH的手术方法存在争议。建议前路入路,虽然后外侧入路是非钙化的首选方法,paramedian,和外侧疝.目前,关于更具侵入性的手术方法的优越性的证据有限,例如CTV或TP,在TF上,一种相对较少侵入性的方法,就神经结果而言,疼痛,和手术并发症,用于治疗cTDH。
方法:回顾性研究,观察,单中心研究是对接受有症状的cTDH的后外侧胸部入路的患者进行的,2010年至2023年,在我们的研究所。起草了三个小组,根据所使用的手术方法:TF,TP,CTV所有手术均在术中CT扫描的辅助下进行,脊髓神经导航,术中神经监测。分析的因素包括手术时间,骨去除量,术中失血,脑脊液渗漏,医源性不稳定需要仪器,椎间盘突出的程度,脊髓病恢复。之后,进行了统计分析,以研究椎体上后缘的骨切除。主要结果是部分或完全去除疝。
结果:本研究连续纳入65例接受cTDH后外侧胸外科手术的患者。TF方法最少,CTV时间最长(p<0.01)。在上述三种方法之间没有观察到统计学差异,术中失血,硬膜渗漏,切除后器械,完全去除疝,或者脊髓病的恢复.一个额外的体骨切除是成功实现全疝清除(P<0.01),骨切除程度与疝切除程度成正比(p<0.01)。
结论:TP,TF,和CTV关于cTDH去除的程度,术后并发症,和神经系统的改善。所描述的躯体骨切除术实现了显着的全疝切除,并且与手术前相对于前后直径差异成正比。
OBJECTIVE: To compare the costotransversectomy (CTV) and transpedicular (TP) approaches versus the transfacet (TF) approach for the surgical treatment of calcific thoracic spine herniations (cTDH), in terms of surgical and clinical outcomes.
BACKGROUND: Surgical approaches for cTDH are debated. Anterior approaches are recommended, while posterolateral approaches are preferred for non-calcific, paramedian, and lateral hernias. Currently, there is limited evidence about the superiority of a more invasive surgical approach, such as CTV or TP, over TF, a relatively less invasive approach, in terms of neurological outcome, pain, and surgical complications, for the treatment of cTDH.
METHODS: A retrospective, observational, monocentric study was conducted on patients who underwent posterolateral thoracic approaches for symptomatic cTDH, between 2010 and 2023, at our institute. Three groups were drafted, based on the surgical approach used: TF, TP, and CTV. All procedures were assisted by intraoperative CT scan, spinal neuronavigation, and intraoperative neuromonitoring. Analyzed factors include duration of surgery, amount of bone removal, intraoperative blood loss, CSF leak, need of instrumentation for iatrogenic instability, degree of disc herniation removal, myelopathy recovery. Afterwards, a statistical analysis was performed to investigate the bony resection of the superior posterior edge of the vertebral soma. The primary outcome was the partial or total herniation removal.
RESULTS: This study consecutively enrolled 65 patients who underwent posterolateral thoracic surgery for cTDH. The TF approach taking the least, and the CTV the longest time (p < 0.01). No statistical difference was observed between the three mentioned approaches, in terms of intraoperative blood loss, dural leakage, post-resection instrumentation, total herniation removal, or myelopathy recovery. An additional somatic bony resection was successful in achieving total herniation removal (p < 0.01), and the extent of bony resection was directly proportional to the extent of hernia removal (p < 0.01).
CONCLUSIONS: No statistically significant differences were highlighted between the TP, TF, and CTV regarding the extent of cTDH removal, the postoperative complications, and the neurological improvement. The described somatic bone resection achieved significant total herniation removal and was directly proportional to the preop against postop anteroposterior diameter difference.