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Paul M. Arnold

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Robert F. Heary and Paul M. Arnold

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Paul M. Arnold, Paul A. Anderson and Robert F. Heary

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Paul A. Anderson, Paul M. Arnold and Robert F. Heary

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Robert F. Heary, Paul A. Anderson and Paul M. Arnold

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Paul M. Arnold

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Paul M. Arnold, Philip L. Johnson and Karen K. Anderson

Object

Symptomatic thoracic disc herniations (TDHs) are rare, and multiple TDHs account for an even smaller percentage of symptomatic herniated discs. Most TDHs are found in the lower thoracic spine, with more than 75% occurring below T-8. The authors report a series of 15 patients with multiple symptomatic TDHs treated with a modified transfacet approach.

Methods

Fifteen patients (9 women and 6 men) with a total of 32 symptomatic TDHs were treated surgically at the authors' institution between 1994 and 2010. The average patient age was 51.1 years. Thirteen patients had 2-level herniation and 2 patients had 3-level disease. The most commonly involved level was T7–8 (10 herniations), followed by T6–7 and T8–9 (6 herniations each). All patients had long-standing myelopathic and/or radicular complaints at the time of presentation. Each disc that exhibited radiographically confirmed compression of the spinal cord or nerve root was considered for resection. Only patients with lateral disc herniations were considered for the modified transfacet approach; patients with a centrally herniated disc underwent ventral or ventral-lateral procedures. The average follow-up time was 30 months.

Results

All patients had successful resection of their herniated discs. All patients with preoperative weakness demonstrated improved strength, and 11 of 12 patients with preoperative pain showed improvement in pain. Sensory loss was less consistently improved. The 2 patients who underwent posterior fixation and fusion achieved radiographically confirmed fusion by the 1-year follow-up. Nine of 10 patients who were working returned to their jobs. Eleven of 12 patients with preoperative back or radicular pain had drastic or complete pain resolution; 1 patient had no change in pain. All 7 patients with preoperative ambulatory difficulty had postoperative gait improvement. Complications were minimal.

Conclusions

Multiple symptomatic herniated thoracic discs are rare causes of pain and disability, but should be treated surgically because good outcomes can be achieved with acceptably low morbidity.

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Paul M. Arnold, Robert D. Strang and Danielle Roussel

The purpose of this study was to evaluate the usefulness and efficacy of variable-angle screws in transpedicular fixation.

Sixteen patients (10 men and six women, age range 44–73 years) underwent a posterior transpedicular fixation procedure in which variable-angle screws were placed at two or more levels. Four patients experienced spinal instability secondary to trauma, 10 patients suffered from degenerative spondylosis requiring fusion, and two patients were treated for spinal metastatic disease. All patients underwent posterior transverse process fusion in which autologous bone was used. In total, 37 vertebral levels were fixed with variable-angle screws placed at 22 levels. Postoperatively all patients were fitted with an external orthosis that was worn for 12 weeks. Serial postoperative plain x-ray films were obtained in all cases. Follow-up periods ranged from 11 to 24 months.

Based on clinical and radiographic data, solid fusion was achieved in 14 of 16 patients. There were two early disconnections of the rod/screw connectors, which were related to errors in technique. With the exception of these disconnections, there were no cases of construct failure. There were no wound infections, and no patient experienced a decline in neurological function as compared with preoperative levels. Both instrumentation systems were easy to use, and the flexibility in trajectory allowed for quicker screw placement and decreased operating room time.

Variable-angle pedicle screws are a safe, useful adjunct to transpedicular fixation, particularly in multisegment fixation and in spines with abnormal alignment.