Posterior Transdural Decompression for Thoracic Disc Herniation Causing Myelopathy: A Systematic Review of Outcomes and Safety.

Abstract

Study DesignSystematic Review.ObjectiveTo evaluate neurological outcomes, complication rates, and operative characteristics of the posterior transdural approach for thoracic disc herniation causing myelopathy.MethodsA systematic review was conducted in accordance with PRISMA 2020 guidelines. MEDLINE, Embase, and PubMed were searched from inception to January 2026. Studies including adult patients undergoing posterior transdural decompression for thoracic disc herniation were eligible. Two reviewers independently performed study selection, data extraction, and methodological quality assessment using the Joanna Briggs Institute checklist for case series. Extracted variables included patient demographics, disc characteristics, operative details, neurological outcomes, follow-up duration, and complications.ResultsSeven Level IV studies comprising 74 patients were included. The weighted mean age was 52.8 years, and 70.3% of discs were calcified. The posterior transdural corridor was utilized in all cases; however, ventral durotomy was performed in 72 of 74 patients (97.3%), with preservation of the ventral dura reported in selected cases. Across studies reporting extractable outcome data, 76% of patients demonstrated neurological improvement, 21% remained stable, and 1.4% experienced persistent neurological deterioration. Transient postoperative neurological worsening occurred in 9.5% of patients and resolved in nearly all cases. Cerebrospinal fluid leakage occurred in 4.1%, with reoperation required in 2.7%. No mortality was reported. Reported operative time varied across studies, ranging from a mean of 124 min in the prospective cohort to a mean of 241 min in the transpedicular-transdural series, with other studies reporting median values between 152 and 210 min.ConclusionPosterior transdural decompression for thoracic disc herniation causing myelopathy is associated with favorable neurological outcomes and a low rate of permanent morbidity, even in predominantly calcified or giant disc pathology. In appropriately selected patients, this technique appears to provide effective ventral decompression with an acceptable safety profile.