Tag: Posterolateral approach

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Safety and Efficacy of Real-Time Intraoperative Ultrasound-Guided Posterolateral Thoracic Diskectomy

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.

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Surgical treatment of thoracic disc herniations via tailored posterior approaches

Eur Spine J (2011) 20:1684–1690. DOI 10.1007/s00586-011-1821-7
We present clinical findings, radiological characteristics and surgical modalities of various posterior approaches to thoracic disc herniations and report the clinical results in 27 consecutive patients. Within an 8-year period 27 consecutive patients (17 female, 10 male) aged 30–83 years (mean 53 years.) were surgically treated for 28 symptomatic herniated thoracic discs in our department. Six of these lesions (21%) were calcified. In all cases surgery was performed via individually tailored posterior approaches. We evaluated the pre- and postoperative clinical status and the complication rate in a retrospective study.
Nearly one half of the lesions (46.4%) were located at the three lowest thoracic segments. Clinical symptoms included back pain or radicular pain (77.8%), altered sensitivity (77.8%), weakness (40.7%), impaired gait (51.9%) or bladder dysfunction (22%). Costotransversectomy was performed in 8 patients, 1 lateral extracavitary approach, 2 foraminotomies, 15 transfacet and/or transpedicular approaches and 2 interlaminar approaches were used for removing the pathologies. After a mean follow-up of 38.6 months (3–100 months), complete normalization or reduction of local pain was recorded in 87%of the patients and of radicular pain in 70%of the cases, increased motor strength could be achieved in 55%, sensitivity improved in 76.2% and improvement of myelopathy was noted in 71.4%. Two patients suffered from postoperative impairment of sensory deficits, which in one case was discrete. The overall recovery rate within the modified JOA score was 39.5%. In 1 patient, two revisions were required because of instability and a persisting osteophyte, respectively. The rate of major complications was 7.1% (2/28).
Surgical treatment of thoracic disc herniations via posterior approaches tailored to the individual patient produces satisfying results referring to clinical outcome. Posterior approaches remain a viable alternative for a large proportion of patients with symptomatic thoracic disc herniations.

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