ORIGINAL
Introducción: La hernia discal torácica (HDT) es rara pero potencialmente incapacitante, particularmente cuando se localiza centralmente y está calcificada, presentando desafíos quirúrgicos significativos debido al riesgo de lesión medular. Varios abordajes presentan limitaciones, incluyendo exposición restringida o aumento de complicaciones. Objetivo: Presentar la técnica operatoria y experiencia clínica con microdiscectomía transforaminal extendida (MTFE) con resección de costilla para HDT localizada medialmente. Método: 14 pacientes con HDT mediana fueron sometidos a MTFE extendida con resección parcial de costilla. Las evaluaciones preoperatoria y postoperatoria (10º día, 6º mes) incluyeron Escala Visual Analógica (EVA), Índice de Discapacidad de Oswestry (ODI) y mediciones radiológicas de los ángulos cifóticos segmentarios y de la cifosis torácica (T2-T12). Resultados: Seguimiento medio de 17,78 meses. Razón femenino/masculino 4:10; edad media 50,5 años. Todas las HDT fueron medianas; 10 fueron calcificadas. Tiempo operatorio medio 131,54 minutos; estancia hospitalaria media 1,5 días. Dos pacientes presentaron desgarros durales intraoperatorios; uno tuvo atelectasia postoperatoria. Las puntuaciones EVA y ODI mejoraron significativamente. Los ángulos cifóticos no mostraron cambios estadísticamente significativos. Conclusión: MTFE extendida con resección de costilla es una técnica viable y segura para HDT localizada medialmente, proporcionando corredor quirúrgico adecuado con bajo riesgo de lesión neural.
Introduction: Thoracic disc herniation (TDH) is rare but potentially debilitating, particularly when centrally located and calcified, presenting significant surgical challenges due to spinal cord injury risk. Various approaches have limitations including restricted exposure or increased complications. Objective: To present the operative technique and clinical experience with extended transforaminal microdiscectomy (TFMD) with rib removal for median-located TDH. Methods: 14 patients with midline TDH underwent extended TFMD with partial rib resection. Preoperative and postoperative (10th day, 6th month) assessments included Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and radiological measurements of segmental kyphotic and thoracic kyphosis angles (T2-T12). Results: Mean follow-up was 17.78 months. Female/male ratio 4:10; mean age 50.5 years. All TDHs were midline; 10 were calcified. Mean operative time 131.54 minutes; mean hospital stay 1.5 days. Two patients had intraoperative dural tears; one had postoperative atelectasis. VAS and ODI scores improved significantly. Kyphotic angles showed no statistically significant changes. Conclusion: Extended TFMD with rib resection is a feasible, safe technique for midline-located TDH, providing adequate surgical corridor with low neural injury risk.
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1Department of Neurosurgery, Umraniye Education and Research Hospital, Istanbul, Turkey.
2Department of Neurosurgery, Marmara University Hospital, Istanbul, Turkey.
3Department of Neurosurgery, Medicana Atasehir Hospital, Istanbul, Turkey.
Received Apr 22, 2026
Accepted Accepted May 7, 2026
