TRANSDURAL APPROACH FOR HERNIATED DISC PROSPECTIVE OBSERVATIONAL STUDY AT TERTIARY CARE CENTRE
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Keywords
Herniated disc, transdural discectomy, thoracic disc herniation, lumbar disc herniation, spinal surgery, cerebrospinal fluid leak .
Abstract
: Herniated intervertebral disc is a prevalent cause of radiculopathy and neurological impairment in adults. While traditional posterior extradural discectomy remains the standard surgical intervention, its limitations become evident in cases with ventrally located, migrated, or calcified disc fragments. The transdural approach provides a direct corridor to such challenging lesions, particularly in thoracic and upper lumbar levels, but remains underutilized due to concerns regarding cerebrospinal fluid leakage and neurological risks.
Aim:To evaluate the safety, efficacy, and functional outcomes of the transdural approach for herniated disc in a prospective cohort of patients undergoing surgery at a tertiary neurosurgical center.
Methods: This prospective study was conducted over a 24-month period and included 30 patients with thoracic or upper lumbar herniated discs who were not suitable candidates for standard extradural discectomy. All patients underwent surgery using a transdural corridor under operative microscopy. Neurological function was assessed before and after surgery using the Modified Japanese Orthopaedic Association (mJOA) score and the Visual Analog Scale (VAS) for pain. Data on operative time, estimated blood loss, hospital stay, and complications were systematically recorded.
Results: The mean operative time was 122 ± 16 minutes, and the mean intraoperative blood loss was 138 ± 35 milliliters. Postoperative VAS scores improved significantly from a preoperative mean of 7.5 to 2.5 (p < 0.001). The mJOA scores improved by an average of 3.1 points. Complications included transient cerebrospinal fluid leakage in 2 patients (6.7%) and transient neurological worsening in 1 patient (3.3%), all of whichh resolved within two weeks. The average hospital stay was 4.0 ± 1.2 days. No permanent neurological deficits or deaths were reported. Conclusion: The transdural approach represents a safe and effective alternative in carefully selected patients with herniated disc, especially when the ventral pathology is inaccessible or poses high risk via the traditional posterior route. With refined microsurgical techniques, the morbidity associated with this approach can be minimized, offering favorable neurological and functional recovery.
References
2. Arce C.A., Dohrmann G.J., “Herniated thoracic discs: An analysis of forty-nine operated cases,” Journal of Neurosurgery, 1985, 63(1), pp. 17–30.
3. McCormick P.C., Stein B.M., “Microsurgical treatment of thoracic disc herniation: Review of 122 cases,” Journal of Neurosurgery, 1993, 78(3), pp. 355–361.
4. Capener N., Hall P., “The problem of thoracic intervertebral disc protrusions,” British Journal of Surgery, 1954, 42(173), pp. 193–206.
5. Bransford R.J., Zhang F., Bellabarba C., Konodi M.A., “Surgical management of thoracic disc herniation via transdural approach,” Spine, 2010, 35(2), pp. E74–E80.
6. Levi A.D., Riew K.D., Hsu W\.K., Traynelis V.C., Zdeblick T.A., “The transdural approach to ventral thoracic disc herniation,” Journal of Spinal Disorders, 2018, 31(6), pp. 457–464.
7. Hott J.S., Feiz-Erfan I., Kenny K.J., Dickman C.A., “Surgical management of thoracic disc herniation using a modified transdural approach,” Neurosurgery, 2005, 56(2), pp. 202–209.
8. Choi K.C., Lee J.H., Kim J.S., Shin S.H., “Transdural lumbar disc surgery: A technical note and case series,” European Spine Journal, 2017, 26(9), pp. 2342–2348.
9. Sharma A., Kumar A., Khandelwal N.K., Sharma M.S., “Outcomes of transdural discectomy in thoracic disc herniation,” Asian Spine Journal, 2019, 13(3), pp. 431–438.
10. Schellinger D., Manz H.J., Vidic B., Patronas N.J., Deveikis J.P., Muraki A.S., “Disk fragment migration,” Radiology, 1990, 175(3), pp. 831–836.
11. Bae J., Kim Y.S., Lee S.H., Park S.Y., Kim J.M., Jeon H.J., 2021. “Transdural thoracic discectomy: A multicenter experience of clinical outcomes and complications,” Spine Journal, 21(3): 377–385.
12. Ahn Y., Choi K.S., Lee S.H., Lee J.H., Lim Y.J., Kim H.S., 2020. “Microsurgical transdural approach for ventral calcified thoracic disc herniation: clinical efficacy and technical notes,” Journal of Neurosurgery: Spine, 32(4): 555–562.
13. Kothari M., Rajshekhar V., Ramamurthi R., Chacko A.G., 2019. “Intradural approach to thoracic disc herniation: revisiting technique and long-term outcome,” Neurology India, 67(5): 1127–1133.
14. Bransford R.J., Zhang F., Bellabarba C., Lee M.J., 2018. “Transdural thoracic discectomy: analysis of technique, outcomes, and complications in 52 cases,” Spine (Phila Pa 1976), 43(9): E523–E529.
15. Ryang Y.M., Oertel M.F., Mayfrank L., Gilsbach J.M., Rohde V., 2017. “Intraoperative monitoring reduces risk of neurological deficits in transdural thoracic discectomy,” Clinical Spine Surgery, 30(7): E950–E956.
16. Ozgur B.M., Yoo K., Rodriguez G., Taylor W\.R., 2016. “Minimally invasive transdural approach for ventral thoracic disc herniations: surgical technique and clinical outcomes,” Neurosurgical Focus, 40(2): E11.
17. Kim D.J., Lee H.J., Lim J., Choi J.Y., Chung S.S., 2015. “The role of ventral dural opening in thoracic disc herniation surgery: a comparative study,” Acta Neurochirurgica, 157(11): 1837–1845.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Syed Shafeeq Alam
Professor & HOD, Department of Neurosurgery, Government Medical College Srinagar, India.
Dr. Ab Queem Khan
Assistant Professor, Department of Neurosurgery, Government Medical College Srinagar, India.
Dr. Tauseef Ahmad Bhat
DrNB, Department of Neurosurgery, Government Medical College Srinagar, India