An analysis of a national database showed that utilizing minimally invasive techniques to treat thoracic disc inhibitor Axitinib herniation has become a new trend [29]. Despite the advancement in surgical instruments and techniques, surgically treating thoracic herniation remains a challenge because of the anatomical characteristics of the thoracic spine. Currently there are still no universally agreed upon indications for surgery, and the optimal type of decompression method is still controversial. Until a gold standard treatment is established, surgeons worldwide will employ different surgical techniques to treat thoracic disc herniations. And the choice of the technique will be dependent on the surgeon’s training background, clinical experience, and personal preference.

Techniques using transforaminal approaches to treat thoracic disc herniation have a few advantages. The techniques generally need to remove only a small, lateral part of the facet joint to gain access for surgical and visualization instruments, and they generally do not require the resection of the unilateral facet joint and the caudal pedicle. Compared with posterior and anterior approaches, transforaminal approaches preserve postoperative spinal stability by avoiding resection of posterior vertebral elements and significantly reduce operative blood loss and postoperative pain by avoiding soft tissue dissection. In our case series, thoracic disc herniations occurred at a wide range of disc levels (from T5-6 to T12-L1). Severe mid back pain with or without radiation was the chief complaint among all the patients treated.

All patients reported immediate pain relief after the surgery, and at the final followup, the majority of the patients were still satisfied with the surgical outcome. This encouraging result suggests that our surgical technique is effective in improving the symptoms of thoracic herniations at different disc levels. When using a similar technique to treat soft thoracic disc herniations, Choi et al. also achieved satisfying results [28], which indicates the technique is reproducible. In our study, at the final followup, 3 of the 13 patients (patients 1, 2, and 9 in Table 1) reported worsened functionality, as assessed by ODI scores. However, the worsened scores were most likely caused by factors unrelated to the original thoracic surgery.

Before undergoing the thoracic discectomy at our center, patient number 1 had lumbar discectomy at L4-5 and L5-S1 levels. At the time when the patient answered the ODI questionnaire for our final followup assessment, the patient was suffering from recurrent L4-5 and L5-S1 herniations, which might be the reason that the patient gave poor ODI scores. Patient number AV-951 2 gave positive feedback right after the thoracic surgery, but she developed lumbar spondylolisthesis later.