The posterior approach for removal of all thoracic disc herniations: a single-surgeon experience using the partial transpedicular approach with ultrasonic bone aspiration and ultrasound guidance in 108 consecutive patients.

Abstract

Thoracic disc herniation (TDH) remains a complex surgical challenge due to its ventral location, frequent calcification, and potential for severe neurological compromise. Anterior and lateral approaches, though effective, are associated with significant morbidity and technical demands. Posterior approaches offer a familiar alternative but have historically been limited in access and safety. The integration of intraoperative ultrasound (IOUS) and ultrasonic aspiration (UA) may enhance the safety and efficacy of posterior decompression techniques. The objective of this study was to evaluate the safety, efficacy, and versatility of a posterior partial transpedicular approach using IOUS and UA for symptomatic TDH in a large single-surgeon cohort. A retrospective review was performed on 108 consecutive patients (137 TDHs) who underwent posterior partial transpedicular discectomy using IOUS and UA by a single surgeon between 2012 and 2024. Clinical, radiographic, and operative data were collected. Frankel grades were assessed preoperatively, at 3-6 months, and at final follow-up. Multivariate regression was used to identify predictors of neurological improvement. The mean ± SD age was 58.6 ± 13.8 years, and 54.7% of patients were female. Most patients presented with myelopathy (86.1%) and giant disc herniations (> 40% stenosis) (68.6%). IOUS and UA facilitated safe decompression in all cases. The mean Frankel grade improved from 3.77 preoperatively to 4.54 at last follow-up (p < 0.001), with 61.1% of patients improving by at least 1 grade. The complication rate requiring reoperation was 9.3%. Comorbidities such as diabetes and obesity were associated with less neurological improvement. This large single-surgeon series demonstrated that the posterior partial transpedicular approach augmented with IOUS and UA is a safe, effective, and widely applicable technique for TDH, including large and calcified lesions. The method provides significant neurological improvement with an acceptable complication profile and can be readily adopted by general spine surgeons.