Fewer Neural Deficits With Anterior Approach to Disc Herniations

The anterior approach to thoracic disc herniation was associated with fewer postoperative neural deficits in a new study.

The study, “Lower Neurological Risk with Anterior Operations Compared to Posterior Operations for Thoracic Disc Herniations,” is published in the February 1, 2022 issue of the journal Spine.

“Anterior and posterior approaches for thoracic disc herniation carry high reported neurological risk, albeit comparative risk is not well defined,” study authors wrote.

For their retrospective study, they used Health Care Utilization Project state inpatient databases to compare rates of postoperative neural deficits between surgical approaches for thoracic disc herniations.

They assessed demographics, operative details, surgical approach, neural injury, length of stay, and discharge location.

Overall, they collected data on 697 patients with a mean age of 52.0 years. The majority of operations were elective and one to two levels.

The study authors found that the neural rate overall was 9.0% with anterior operations having a significantly lower rate compared with posterior operations (4.6% vs. 11.4%; p < 0.01) on univariate analysis.

Multilevel analysis showed that posterior approaches (RR 1.78; p = 0.12) and combined approaches (RR 2.15; p = 0.17) had higher risk of neural injury than anterior approaches after adjusting for younger age, higher Charlson Comorbidity Index, and nonelective admissions. Combined and posterior operations had similar neural injury rates, however, combined approaches had significantly longer length of stay and skilled nursing facility discharges compared with single approaches.

The researchers also found that neural deficit was associated with discharge to skilled nursing facility (with = 87.3%; without =23.7%; p < 0.01) and increased length of stay (with = 12.5 days; without = 6.9 days; p < 0.01).

“Overall rate of neural deficit after operation for thoracic disc herniation was 9.0%. While anterior approach was associated with a lower neural injury rate, this association was confounded by age, Charlson Comorbidity Index, and admission type. After correcting for these confounders, a nonsignificant trend remained that favored the anterior approach. Neural deficit was associated with increased length of stay and discharge to skilled nursing facility postoperative,” they wrote.

The study authors included Daniel Cummins, Matthew Callahan, Aaron J. Clark, M.D., Ph.D., and Alekos A. Theologis, M.D., all of the University of California – San Francisco.