Benchmarking surgical approaches to thoracic disc herniation: A retrospective database study

Background

Thoracic disc herniations are a relatively uncommon form of degenerative disc disease, comprising an estimated 0.1–3 % of all spinal disc herniations. Surgical treatment may utilize an anterior, lateral, or posterior/posterolateral approach, and approach selection is based on a number of factors.

Objective

This study investigated national trends in surgical approach utilization as well as patient characteristics predictive of receiving a specific surgical approach.

Methods

This was a retrospective study querying the TriNetX national database. Patients were identified through specific ICD-9 coding for degenerative thoracic disc herniation and CPT coding for thoracic spinal procedures.

Results

Of 3009 total patients meeting inclusion criteria, 2703 patients (89.8 %) underwent decompression through a posterior or posterolateral approach, 222 (7.4 %) via anterior approach, and 84 (2.8 %) via lateral extracavitary approach. The number of posterior or posterolateral operations notably increased from 43 cases in 2010 to over 240 cases per year from 2022 to 2024. In contrast, anterior approach procedures reached a peak of 27 cases in 2017 and declined to 13 or fewer cases per year since.

Conclusion

Most thoracic disc herniation patients in the TriNetX database received surgical decompression via a posterior or posterolateral approach. Although the annual number of surgeries performed for thoracic disc herniation patients increased after 2017, there was a decreased utilization of anterior approaches. This study demonstrates the widespread utilization of posterolateral-based approaches in the surgical management of thoracic disc herniations.