Operative Neurosurgery 31:20–27, 2026
This article reports a single-center retrospective case series evaluating real-time intraoperative ultrasound (IOUS)-guided posterolateral thoracic diskectomy for symptomatic thoracic disk herniation (TDH). The study of 32 patients (41 levels) demonstrates significant reductions in pain and Nurick scores, low blood loss, moderate operative times, no postoperative complications, and high fusion rates at follow-up.
The manuscript details patient selection, surgical technique using IOUS for direct ventral cord visualization during posterolateral diskectomy, perioperative outcomes, and limitations. Authors conclude IOUS-guided posterolateral diskectomy is a safe, effective, and broadly adoptable method that improves decompression while minimizing morbidity compared with traditional anterior or lateral approaches.
Clinical problem: Thoracic disk herniation surgery is technically challenging because the thoracic canal is narrow and the spinal cord blocks direct access/visualization of ventral pathology.
Technique: Real-time intraoperative ultrasound (IOUS) is used during a posterolateral thoracic diskectomy to directly visualize the spinal cord and TDH, guide instrument positioning, and confirm decompression intraoperatively.
Study design: Retrospective single-surgeon series of symptomatic TDH patients treated with IOUS-guided posterolateral diskectomy from May 2020 to Feb 2025 at a major academic center.
Cohort details: 32 patients (41 levels); 50% had calcified disks (n=16), predominantly central lesions (n=13), including 2 “giant” TDHs (>40% canal).
Key operative steps: Laminectomy and partial bony removal (including <¼ pedicle), creation of a cavity by removing small cranial/caudal endplate portions, then using an ultrasound-visualized curette to push the disk fragment ventrally into the cavity for safe removal, with repeat IOUS confirmation of anterior cord decompression.
Clinical outcomes: Significant improvement in pain and neurological/ambulatory function (VAS 5.9±2.0 to 1.8±1.2; Nurick 2.8±0.7 to 1.0±0.8; P<.001 for both).
Perioperative metrics: Mean operative time 132.8±32.9 minutes, mean blood loss 118.1±77.6 mL, and average length of stay 4.7±2.6 days.
Safety/fusion: No postoperative complications were observed; among those with ≥1-year follow-up (30/32), all achieved Lenke-Bridwell Grade A or B fusion without pseudarthrosis or revision surgery.