• Alexandros G Brotis, Anastasia Tasiou, Kostantinos Paterakis, Christos Tzerefos, and Kostas N Fountas.
• Department of Neurosurgery, University Hospital of Larissa, Larissa, Thessaly, Greece. Electronic address: amprotis@med.uth.gr.
• World Neurosurg. 2019 Dec 1; 132: 334-342.

BackgroundA systematic review and network meta-analysis (Prospero ID CRD42018106936) were performed.ObjectiveThe selection of the appropriate surgical approach for the management of thoracic disc herniation (TDH) is often challenging because of the frequency and variability of the associated complications. We evaluated the safety of the surgical approaches for TDH by estimating the mortality (Q1) and morbidity (Q2), and frequency of the most common complications (Q3).MethodsWe searched the medical literature for randomized controlled trials and observational studies reporting on the management of TDH. Postoperative complications were the outcome of interest. The absolute and relative risk estimates, along with the rank probability scores, were estimated for each approach, through a network meta-analysis. The results were read in the light of the quality of the available evidence.ResultsFifteen studies with a total of 1036 patients fulfilled our eligibility criteria. Three deaths were reported. The overall morbidity was as high as 29%, largely attributed to medical (21%; 95% confidence interval [CI], 10%-38%), surgical site (11%; 95% CI, 5%-22%), cerebrospinal fluid-related (8%; 95% CI, 3%-8%), and neurologic complications (5%; 95% CI, 1%-24%). The anterior and lateral approaches were associated with a higher risk for medical and surgical complications compared with the posterolateral approach.ConclusionsSurgery for TDH is associated with minimal mortality but significant morbidity, with large variations among the available approaches. An understanding of the perioperative complications rates is important to develop complication avoidance strategies and to aid accurate patient-to-doctor communication.Copyright © 2019 Elsevier Inc. All rights reserved.

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