Safety and Efficacy of Real-Time Intraoperative Ultrasound-Guided Posterolateral Thoracic Diskectomy: Using Technology to Minimize Complication and Improve Surgical Outcome

BACKGROUND AND OBJECTIVES: – Surgical Treatment of thoracic disk herniation (TDH) can be challenging due to the thoracic spine's relatively narrow canal with spinal cord blocking 0direct access and visualization of the TDH. This study evaluates the efficacy and safety of real-time intraoperative ultrasound (IOUS)-guided posterolateral diskectomy for TDH.METHODS: – A retrospective analysis was conducted on patients with symptomatic TDH who underwent IOUS-guided surgery between May 2020 and February 2025 treated by a single surgeon at a major academic center. Patient demographics and perioperative Visual Analogue Scale pain score and Nurick grading for neurological function were assessed and analyzed.RESULTS: – A total of 32 patients met inclusion criteria for final analysis, comprising a total of 41 levels. Thoracic disk calcification was observed in 50% of cases (n = 16), with central lesions (n = 13) substantially outnumbering paracentral lesions (n = 3). Significant improvements were observed in both pain and neurological function: preoperative Visual Analogue Scale scores decreased from 5.9 ± 2.0 to 1.8 ± 1.2 postoperatively (P < .001), and Nurick grades improved from 2.8 ± 0.7 to 1.0 ± 0.8 (P < .001). Mean operative time was 132.8 ± 32.9 minutes, with blood loss of 118.1 ± 77.6 mL. No postoperative complications were observed. The average length of stay was 4.7 ± 2.6 days.CONCLUSION: – Real-time IOUS-guided posterolateral diskectomy provides direct visualization of spinal cord during posterolateral thoracic diskectomy, and ensures adequate decompression, enabling safe removal of TDH with direct real-time visualization and confirmation of spinal cord decompression. The technique significantly alleviates pain, improves ambulatory function, and avoids complications associated with traditional anterior or lateral approaches.