TY - JOUR
T1 - Outcome and negative events in thoracic disc herniation surgery:
T2 - A Danish registry study
AU - Wichmann, Thea Overgaard
AU - Bazys, Mindaugas
AU - Gudmundsdottir, Gudrun
AU - Gram Carlsen, Jakob
AU - Duel, Peter
AU - Valancius, Kestutis
AU - Katballe, Niels
AU - Rasmussen, Mikkel Mylius
PY - 2021
Y1 - 2021
N2 - Background: Thoracic disc herniation (TDH) is a surgically demanding entity. Various surgical approaches have been developed and advanced in an attempt to achieve sufficient outcomes and reduce consecutive complication rates. Still, controversy exists regarding selecting the best surgical approach. This retrospective study aims to support decision-making regarding surgical approach. Methods: We performed a retrospective analysis of 71 patients who underwent thoracic discectomy at Aarhus University Hospital, Denmark, between 1996 and 2015. Patients were divided into two groups depending on whether a lateral approach or a posterior approach was used. Data on demographics, symptomatology, peri- and post-operative events, length of hospitalization and discharge disposition were assembled from medical records. Results: Lateral and posterior approach had an approximately equal peri-operative event rate (39% versus 36%), whereas the lateral approach was associated with a higher post-operative event rate in-hospital and post-discharge than the posterior approach (50% versus 18%; 45% versus 40%). The overall probability of improvement in clinical outcome regardless approach at follow-up was 77% in the short-term and 80% in the long-term. Odds of clinical improvement at any time point was 29% higher with the lateral approach than with the posterior approach (OR = 1.29, 95% CI: 0.52–3.21, p =.76). Adjusting for time, the odds of clinical improvement at short-term follow-up was twice as high for the lateral than for the posterior approach (OR = 2.16, 95% CI: 0.16–30.11); however, the trend seems to fade away over time (OR = 1.10, 95% CI: 0.07–17.55). Conclusions: The probability of improving after TDH surgery is good. However, a clear conclusion regarding the best surgical approach cannot be established; thus, surgeons should consider pros and cons of each approach when allocating a patient to surgery.
AB - Background: Thoracic disc herniation (TDH) is a surgically demanding entity. Various surgical approaches have been developed and advanced in an attempt to achieve sufficient outcomes and reduce consecutive complication rates. Still, controversy exists regarding selecting the best surgical approach. This retrospective study aims to support decision-making regarding surgical approach. Methods: We performed a retrospective analysis of 71 patients who underwent thoracic discectomy at Aarhus University Hospital, Denmark, between 1996 and 2015. Patients were divided into two groups depending on whether a lateral approach or a posterior approach was used. Data on demographics, symptomatology, peri- and post-operative events, length of hospitalization and discharge disposition were assembled from medical records. Results: Lateral and posterior approach had an approximately equal peri-operative event rate (39% versus 36%), whereas the lateral approach was associated with a higher post-operative event rate in-hospital and post-discharge than the posterior approach (50% versus 18%; 45% versus 40%). The overall probability of improvement in clinical outcome regardless approach at follow-up was 77% in the short-term and 80% in the long-term. Odds of clinical improvement at any time point was 29% higher with the lateral approach than with the posterior approach (OR = 1.29, 95% CI: 0.52–3.21, p =.76). Adjusting for time, the odds of clinical improvement at short-term follow-up was twice as high for the lateral than for the posterior approach (OR = 2.16, 95% CI: 0.16–30.11); however, the trend seems to fade away over time (OR = 1.10, 95% CI: 0.07–17.55). Conclusions: The probability of improving after TDH surgery is good. However, a clear conclusion regarding the best surgical approach cannot be established; thus, surgeons should consider pros and cons of each approach when allocating a patient to surgery.
KW - Thoracic disc herniation
KW - discectomy
KW - negative events
KW - outcome
KW - surgical approach
KW - Intervertebral Disc Displacement/epidemiology
KW - Humans
KW - Patient Discharge
KW - Treatment Outcome
KW - Denmark/epidemiology
KW - Aftercare
KW - Thoracic Vertebrae/surgery
KW - Registries
KW - Diskectomy
KW - Retrospective Studies
U2 - 10.1080/02688697.2020.1861429
DO - 10.1080/02688697.2020.1861429
M3 - Journal article
C2 - 33345627
SN - 0268-8697
VL - 35
SP - 456
EP - 461
JO - British Journal of Neurosurgery
JF - British Journal of Neurosurgery
IS - 4
ER -