Thoracic Discectomy Through a Unilateral Transpedicular or Costotransversectomy Approach With Intraoperative Ultrasound Guidance

2018 ◽  
Vol 17 (3) ◽  
pp. 332-337
Author(s):  
Aaron Wessell ◽  
Harry Mushlin ◽  
Charles Fleming ◽  
Evan Lewis ◽  
Charles Sansur
Keyword(s):  
Disc Herniation ◽  
Ultrasound Image ◽  
Intraoperative Ultrasound ◽  
Thoracic Disc Herniation ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Clinical Records ◽  
Thoracic Discectomy ◽  
Thoracic Disc

Abstract BACKGROUND The disc location, extent of calcification, limited visualization of the ventral cord, and tenuous blood supply to the thoracic spinal cord pose unique technical challenges when surgically treating thoracic disc herniation. OBJECTIVE To report our initial experience with a series of cases in which intraoperative ultrasound image guidance was used for thoracic discectomy through a unilateral transpedicular or costotransversectomy approach. METHODS Five patients (n = 5) underwent a transpedicular approach and five (n = 5) underwent costotransversectomy for thoracic discectomy. Pre- and postoperative clinical records, operative reports, disc location/calcification, and complications were reviewed. RESULTS There were 6 (n = 6) males and 4 (n = 4) females with an average age of 54 yr (range: 33-74). All patients had symptoms attributable to a single-level of thoracic disc herniation. Discs were classified as central (n = 5) and paracentral (n = 5). Preoperative CT and/or intraoperative visualization demonstrated calcified disc material in 6 (n = 6) patients. Final outcomes data at last follow-up was available for 9 of 10 patients. Eight of these nine patients experienced a return to normal baseline functional status. Postoperative imaging confirmed that no wrong-level surgeries were performed. The mean length of follow-up was 20.4 wk (range 4-48). CONCLUSION Thoracic discectomy with ultrasound visualization via a unilateral transpedicular or costotransversectomy approach is safe and effective for treatment of central and paracentral calcified disc herniations. This tool improves the safety profile of thoracic discectomy and allows for treatment of thoracic discs through less invasive approaches.

scholarly journals Laminotomy/medial facet approach in the excision of thoracic disc herniation

2000 ◽  
Vol 9 (4) ◽  
pp. 1-3 ◽  
Author(s):  
Perry Black
Keyword(s):  
Disc Herniation ◽  
Facet Joint ◽  
Thoracic Disc Herniation ◽  
Leg Weakness ◽  
Thoracic Discectomy ◽  
Thoracic Disc

Object The author describes a technique of thoracic discectomy that has evolved from the posterolateral transfacet and the transpedicular approaches but that spares the pedicle and most of the facet joint. Methods This approach was used to remove a total of 11 discs (T6–12) in seven patients. The follow-up period ranged from 8 months to 3 years. In four patients with axial and/or girdle pain significant improvement was demonstrated. The paraparesis in one patient with myelopathy improved postoperatively; that in another patient improved but recurred 8 months postoperatively. In one patient who experienced preoperative leg weakness, the weakness was slightly increased postoperatively, but this sequela was only transient. There were no other complications, and there were no deaths. Conclusions This technique appears safe and effective. It can be adapted to the conventional laminectomy known to spine surgeons and requires no specialized instruments. Further trials appear warranted.

scholarly journals Revision surgery in thoracic disc herniation

2019 ◽  
Vol 29 (S1) ◽  
pp. 39-46
Author(s):  
Stephan Dützmann ◽  
Roli Rose ◽  
Daniel Rosenthal
Keyword(s):  
Disc Herniation ◽  
Revision Surgery ◽  
Cord Compression ◽  
Thoracic Disc Herniation ◽  
Disc Disease ◽  
Neurological Improvement ◽  
Initial Symptoms ◽  
Disc Herniations ◽  
Clinical Records ◽  
Thoracic Disc

Abstract Purpose Surgical treatment failures or strategies for the reoperation of residual thoracic disc herniations are sparsely discussed. We investigated factors that led to incomplete disc removal and recommend reoperation strategies. Methods As a referral centre for thoracic disc disease, we reviewed retrospectively the clinical records and imaging studies before and after the treatment of patients who were sent to us for revision surgery for thoracic disc herniation from 2013 to 2018. Results A total of 456 patients were treated from 2013 to 2018 at our institution. Twenty-one patients had undergone previously thoracic discectomy at an outside facility and harboured residual, incompletely excised and symptomatic herniated thoracic discs. In 12 patients (57%), the initial symptoms that led to their primary operation were improved after the first surgery, but recurred after a mean of 2.8 years. In seven patients (33%) they remained stable, and in two cases they were worse. All patients were treated via all dorsal approaches. In all 21 cases, the initial excision was incomplete regarding medullar decompression. All of the discs were removed completely in a single revision procedure. After mean follow-up of 24 months (range 12–57 months), clinical neurological improvement was demonstrated in seven patients, while three patients suffered a worsening and 11 patients remained stable. Conclusion Our data suggest that pure dorsal decompression provides a short relief of the symptoms caused by spinal cord compression. Progressive myelopathy (probably due to mechanical and vascular deficits) and scar formation may cause worsening of symptoms. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

scholarly journals Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Hong-Fei Nie ◽  
Kai-Xuan Liu
Keyword(s):  
Disc Herniation ◽  
Surgical Approaches ◽  
Invasive Technique ◽  
Complication Rates ◽  
Thoracic Disc Herniation ◽  
Blood Patch ◽  
The Mean ◽  
Thoracic Disc ◽  
Rib Head

Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6–41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery.

scholarly journals THORACIC DISC HERNIATION: SURGICAL DECOMPRESSION BY POSTERIOR APPROACH A LA CARTE

2016 ◽  
Vol 15 (3) ◽  
pp. 213-218 ◽  
Author(s):  
MURILO TAVARES DAHER ◽  
PEDRO FELISBINO JUNIOR ◽  
ADRIANO PASSÁGLIA ESPERIDIÃO ◽  
BRENDA CRISTINA RIBEIRO ARAÚJO ◽  
ANDRÉ LUIZ PASSOS CARDOSO ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Posterior Approach ◽  
Surgical Decompression ◽  
Thoracic Disc Herniation ◽  
Transpedicular Approach ◽  
Partial Body ◽  
The Mean ◽  
Thoracic Disc ◽  
A La Carte

ABSTRACT Objectives: To present the clinical and radiographic results of patients with thoracic disc herniation treated by the posterior approach, according to location and type of hernia (à la carte). Methods: We evaluated thirteen patients (14 hernias) treated by the posterior approach. Eight (61.5%) patients were male and the mean age was 53 years (34-81). Clinical evaluation was performed by the Frankel and JOA modified scales. All the patients underwent the posterior approach, which was performed by facetectomy, transpedicular approach, transpedicular + partial body resection, costotransversectomy or costotransversectomy + reconstruction with CAGE. Results: The mean follow-up was 2 years and 6 months (11-77 months). Of the 14 operated hernias, six (43%) were lateral, 2 (14%) paramedian, and 6 (43%) central. Seven were soft (50%) and seven were calcified. The transfacet approach was carried out in 5 cases (36%), transpedicular in 1 case (7%), transpedicular + partial body resection in 4 (29%), costotransversectomy in 3 (21%), and costotransversectomy + CAGE in one case (7%). The majority of patients with lateral hernia (5/6) were subjected to transfacet decompression and in cases of central and paramedian hernias, all patients underwent decompression, which is more extensive. Conclusions: The posterior approach is safe and effective, and the best approach must be chosen based on location and type of the herniation and the surgeon's experience.

Thoracic Disc Herniation: Operative Approaches and Results

Neurosurgery ◽  
1983 ◽  
Vol 12 (3) ◽  
pp. 303-305 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Peter J. Jannetta
Keyword(s):  
Disc Herniation ◽  
Clinical Presentation ◽  
Thoracic Disc Herniation ◽  
Operative Strategy ◽  
University Of Pittsburgh ◽  
Radiological Features ◽  
Thoracic Disc ◽  
The University ◽  
Lateral Sclerosis

Abstract In a series of 12 cases of thoracic disc herniation operated upon at the University of Pittsburgh, 4 different operative approaches were used. These included laminectomy in 2 early cases, posterolateral extrapleural operation in 5 cases, transthoracic operation in 3 cases, and transpedicular operation in 2 cases. The relative merits of the various approaches are discussed in this paper. The clinical presentation, radiological features, and follow-up data are also presented. Precise preoperative radiological diagnosis was essential in planning the operative strategy. The posterolateral and transpedicular approaches were both satisfactory, but the former had some advantages over the latter. With a mean follow-up period of 5 years, 5 patients were cured, 5 were improved, and 1 was unchanged. One patient was worse due to coexistent amyotrophic lateral sclerosis.

Posterolateral Endoscopic Thoracic Discectomy: Transforaminal Approach

2018 ◽  
Vol 1 (2) ◽  
pp. 20 ◽  
Author(s):  
Sang Ho Lee
Keyword(s):  
Disc Herniation ◽  
Local Anaesthesia ◽  
High Speed ◽  
Herniated Disc ◽  
Intravenous Sedation ◽  
High Morbidity ◽  
Disc Protrusion ◽  
Thoracic Discectomy ◽  
Thoracic Disc

Objective: Symptomatic soft herniated thoracic disc (HTD) before the use of magnetic resonance imaging (MRI) was a rare disease with less than 1% of all spinal disc herniation. The frequency of diagnosis of thoracic disk herniation has increased with the routine use of MRI. To avoid high morbidity and complications associated with conventional approach, the authors applied posterolateral endoscopic technique.Methods: From January 2001 to December 2016, 87 patients with non-sequestrated and soft lateral or central thoracic disc herniation underwent posterolateral endoscopic thoracic discectomy (PLETD). Under local anaesthesia with intravenous sedation, we removed the herniated disc through thoracic intervertebral foramen after foraminoplasty. The enlargement of the foramen by partially cutting the lateral aspect of superior facet with a Reamer or high-speed diamond drills. Clinical outcome was measured by the Oswestry Disability Index (ODI) and the visual analogue scale.Results: Fifty-one males and thirty-six females, aged 21 to 89 years were enrolled in this study. Mean follow-up period was 10 months (1 to 56 months). The mean ODI scores improved from 53.7 before surgery to 16.9 at the final follow-up (p <0.05). Mean VAS scores improved from 7.3 before surgery to 2.1 at the final follow-up (p <0.05). One patient required conversion to an open procedure for recurred disc protrusion in 17 days. Another one patient required repeated PLETD for recurring disc in l year. Three patients experienced transient low extremity paresthesia but all improved. There were no other serious complications associated with this procedure.Conclusion: Conventional treatment of HTD is known for its high morbidity and complications, posing a challenge to physicians. This PLETD technique for symptomatic non-sequestrated and soft HTD is a safe and effective method that provides a direct route to the lesion under local anaesthesia with less morbidity. 

Posterolateral Endoscopic Thoracic Discectomy: Transforaminal Approach

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Sang Ho Lee
Keyword(s):  
Disc Herniation ◽  
Local Anaesthesia ◽  
High Speed ◽  
Herniated Disc ◽  
Intravenous Sedation ◽  
High Morbidity ◽  
Disc Protrusion ◽  
Thoracic Discectomy ◽  
Thoracic Disc

Objective: Symptomatic soft herniated thoracic disc (HTD) before the use of magnetic resonance imaging (MRI) was a rare disease with less than 1% of all spinal disc herniation. The frequency of diagnosis of thoracic disk herniation has increased with the routine use of MRI. To avoid high morbidity and complications associated with conventional approach, the authors applied posterolateral endoscopic technique.Methods: From January 2001 to December 2016, 87 patients with non-sequestrated and soft lateral or central thoracic disc herniation underwent posterolateral endoscopic thoracic discectomy (PLETD). Under local anaesthesia with intravenous sedation, we removed the herniated disc through thoracic intervertebral foramen after foraminoplasty. The enlargement of the foramen by partially cutting the lateral aspect of superior facet with a Reamer or high-speed diamond drills. Clinical outcome was measured by the Oswestry Disability Index (ODI) and the visual analogue scale.Results: Fifty-one males and thirty-six females, aged 21 to 89 years were enrolled in this study. Mean follow-up period was 10 months (1 to 56 months). The mean ODI scores improved from 53.7 before surgery to 16.9 at the final follow-up (p <0.05). Mean VAS scores improved from 7.3 before surgery to 2.1 at the final follow-up (p <0.05). One patient required conversion to an open procedure for recurred disc protrusion in 17 days. Another one patient required repeated PLETD for recurring disc in l year. Three patients experienced transient low extremity paresthesia but all improved. There were no other serious complications associated with this procedure.Conclusion: Conventional treatment of HTD is known for its high morbidity and complications, posing a challenge to physicians. This PLETD technique for symptomatic non-sequestrated and soft HTD is a safe and effective method that provides a direct route to the lesion under local anaesthesia with less morbidity. 

Reversible propriospinal myoclonus due to thoracic disc herniation: Long-term follow-up

2012 ◽  
Vol 313 (1-2) ◽  
pp. 32-34 ◽  
Author(s):  
Wooyoung Jang ◽  
Joong-Seok Kim ◽  
Jin Young Ahn ◽  
Hee-Tae Kim
Keyword(s):  
Disc Herniation ◽  
Thoracic Disc Herniation ◽  
Long Term Follow Up ◽  
Thoracic Disc ◽  
Propriospinal Myoclonus

scholarly journals Thoracic intramedullary neurosarcoidosis with thoracic disc herniation: Diagnostic importance of intramedullary contrast enhancement

2021 ◽  
Vol 12 ◽  
pp. 331
Author(s):  
Justin Beiriger ◽  
Hussam Abou-Al-Shaar ◽  
Hansen Deng ◽  
Mansour Mathkour ◽  
David O. Okonkwo
Keyword(s):  
Spinal Cord ◽  
Contrast Enhancement ◽  
Disc Herniation ◽  
Mediastinal Lymphadenopathy ◽  
Thoracic Disc Herniation ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Radiographic Findings ◽  
Signal Change ◽  
Thoracic Disc

Background: Thoracic intramedullary neurosarcoidosis is an uncommon but serious manifestation of spinal cord disease. Its concomitant occurrence with thoracic disc herniation can mislead the physician into attributing neurologic and radiographic findings in the spinal cord to disc pathology rather than inflammatory disorder. Here, we present such a rare case of concomitant thoracic disc and spinal neurosarcoidosis. Case Description: A 37-year-old male presented with progressive right lower extremity weakness and numbness. Magnetic resonance imaging (MRI) of the thoracic spinal cord revealed a T6-T7 paracentral disc eccentric to the right with T2 signal change extending from T2 to T10 level. This prompted acquiring a contrasted MRI that also depicted intramedullary enhancement around the T6-T7 disc bulge. Computed tomography scan of the chest showed mediastinal lymphadenopathy concerning for sarcoidosis. Lymph node biopsy confirmed the diagnosis of sarcoidosis, and high-dose steroid treatment was initiated. The patient had significant symptomatic improvement with steroids with full neurological recovery and improvement of his symptoms. Conclusion: While stenosis from thoracic disc disease could potentially suggest a mechanical etiology for the patient’s symptoms, attention must be paid to the imaging findings as well as the degree and extent of cord signal change and intramedullary contrast enhancement. Appropriate and timely diagnosis is essential to avoid unnecessary invasive procedures.

scholarly journals Management of Giant Thoracic Disc Herniation by Thoracoscopic Approach: Experience of 53 Cases

2018 ◽  
Vol 16 (6) ◽  
pp. 658-666 ◽  
Author(s):  
David Brauge ◽  
Catherine Horodyckid ◽  
Marta Arrighi ◽  
Vincent Reina ◽  
Christophe Eap ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Surgical Techniques ◽  
Lower Limbs ◽  
Thoracic Disc Herniation ◽  
Long Term Outcome ◽  
Thoracoscopic Approach ◽  
Lower Limb Pain ◽  
Thoracic Disc ◽  
Frankel Grade

Abstract BACKGROUND Giant thoracic disc herniation (gTDH) is a rare condition. It is defined by a herniation that occupies at least 40% of the thoracic spinal canal and is usually calcified. Several surgical techniques have been described to date but this surgery remains a technically difficult procedure. OBJECTIVE To report the long-term outcome of 53 patients with myelopathy due to gTDH who were operated on by a thoracoscopic approach. The technical details of the preoperative assessment and the surgical procedure are presented. METHOD We present a retrospective study of a database of 53 patients operated for symptomatic gTDH by a thoracoscopic approach. The following clinical parameters were assessed initially and used during follow-up: Frankel grade and JOA score adapted to the thoracic spine (mJOA), pain in the lower limbs and limitation of the walking perimeter to less than 500 meters. The quality of spinal cord decompression was assessed postoperatively by magnet resonance imaging (MRI). RESULTS The mean follow-up was 78.1 mo (SD 49.4). At the last follow-up visit, clinical examination showed a mean improvement of 0.91 Frankel grade (P &lt; 0.001) and 2.56 mJOA score respectively (P &lt; 0.001). Lower limb pain and walking perimeter were also improved. Postoperative MRI revealed that the resection was complete in 35 cases, subtotal in 13 cases, and incomplete in 5 cases. CONCLUSION gTDH is a condition that often evolves favorably after surgery. The thoracoscopic approach is a feasible alternative technique.

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