Thoracolumbar Junction Disc Herniations: Clinical Features and Surgical Approaches

Abstract

Objectives: To evaluate the clinical features of thoracolumbar junction(TLJ) disc herniations and to determine appropriate surgical approaches. Materials and Methods: A retrospective analysis of 33 patients with single level TLJ disc herniations undergoing ope- rations was performed. Medical records, operative findings, and radiologic data were assessed. TLJ was defined as the level from T11-12 to L2-3. The mean follow-up period was 21.8 months. Results: Mean age was 47.3 years. Affected disc levels were T11-T12 in 5 patients, T12-L1 in 2 patients, L1-L2 in 6 patients, and L2-L3 in 20 patients. Soft disc herniations were detected in 24 patients, while the remainder showed hard disc herniations such as a bony spur or calcification. Thirty-one patients presented with pain as their chief complaint and radicular pain was the most common symptom(n=14). Various neurologic deficits including upper motor neuron syndrome, lower motor neuron syndrome, and radiculopathy were observed in 27 patients and were not related to the affected levels. Twenty-four patients with lateral disc herniations or central soft disc herniations underwent partial hemilaminectomy and facetectomy, and the remaining patients(n=9) with central disc herniations or severely calcified disc herniations underwent total facetectomy and subsequent posterior fusion. There were 7 cases with complications including dural tear, mild motor and sensory deficits, and bladder and bowel dysfunction without permanent morbidities. Conclusion: TLJ disc herniation shows variable symptoms and signs due to its unique anatomy. It can be safely managed by the correct surgical approach as determined by the location and type of disc herniation.