Management of Thoracic Disc Herniation Using the Mini-Open Retropleural Approach: Technique Illustration and Clinical Outcomes of 33 Patients From a Single Academic Center

2020 ◽  
Vol 19 (5) ◽  
pp. 567-581
Author(s):  
Mohammad Hassan A Noureldine ◽  
Elliot Pressman ◽  
Paul R Krafft ◽  
Marek Molcanyi ◽  
Nam D Tran ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Disc Herniation ◽  
Tube Placement ◽  
Cerebrospinal Fluid Leakage ◽  
High Morbidity ◽  
Complication Rates ◽  
Thoracic Disc Herniation ◽  
Academic Center ◽  
Thoracic Disc ◽  
Mini Open

Abstract BACKGROUND Conventional surgical approaches used in the management of thoracic disc herniation (TDH) are associated with high morbidity. The development of minimally invasive and mini-open approaches has consistently improved patient outcomes. OBJECTIVE To report our experience and outcomes of patients with symptomatic TDHs who underwent discectomy and partial corpectomy using the mini-open retropleural (MORP) approach as well as provide a detailed and illustrated technical description of the approach. METHODS Retrospective chart review was performed on all patients with symptomatic TDHs who underwent a MORP approach at a tertiary academic center between 2011 and 2019. Patient demographic, clinical, and imaging data were examined (n = 33). The surgical technique is illustrated and described in detail. RESULTS Discectomy of the herniated thoracic discs was successfully achieved in all patients using the MORP approach. Calcified discs were present in 63.6% (n = 21) of patients. Immediate instrumentation and fusion were performed in 30.3% (n = 10) of patients, which were among the earlier cases in this series. Symptomatic pleural effusions and cerebrospinal fluid leakage occurred in 6.1% (n = 2) and 9.1% (n = 3), respectively. No patient required chest tube placement. CONCLUSION The MORP approach described in this manuscript is feasible and safe in achieving discectomy in patients with symptomatic TDHs. Compared to conventional open and other minimally invasive approaches, patients undergoing the MORP approach may have better outcomes with lower complication rates.

Management of Thoracic Disc Herniation Using the Mini-Open Retropleural Approach: Technique Illustration and Clinical Outcomes of 33 Patients From a Single Academic Center

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S154-S154
Author(s):  
Mohammad Hassan A Noureldine ◽  
Elliot Pressman ◽  
Paul R Krafft ◽  
Marek Molcanyi ◽  
Nam D Tran ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Disc Herniation ◽  
Thoracic Disc Herniation ◽  
Academic Center ◽  
Thoracic Disc ◽  
Mini Open

scholarly journals Posterior Minimally Invasive Transpedicular Approach for Giant Calcified Thoracic Disc Herniation

2020 ◽  
pp. 219256822093327 ◽  
Author(s):  
Daniel Shedid ◽  
Zhi Wang ◽  
Ahmad Najjar ◽  
Sung-Joo Yuh ◽  
Ghassan Boubez ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Disc Herniation ◽  
Case Series ◽  
Thoracic Disc Herniation ◽  
Retrospective Case ◽  
Tubular Retractor ◽  
Posterior Surgery ◽  
Transpedicular Approach ◽  
Dural Tears ◽  
Thoracic Disc

Study Design: Retrospective case series. Objective: Posterior surgery for thoracic disc herniation was associated with increased morbidity and mortality and new minimally invasive approaches have been recommended for soft disc herniation but not for calcified central disc. The objective of this study is to describe a posterolateral microscopic transpedicular approach for central thoracic disc herniation. Methods: This is a single center retrospective review of all the cases of giant thoracic calcified disc herniation as defined by Hott et al. Presence of myelopathy, percentage of canal compromise, T2 hypersignal, ASIA score, and ambulatory status were recorded. This posterolateral technique using a tubular retractor was thoroughly described. Results: Eight patients were operated upon with a mean follow-up of 16 months. Mean canal compromise was 61%. Mean operative time was 228 minutes and mean operative bleeding was 250 mL. There were no cases of dural tear or neurologic degradation. Conclusion: This is the first report of posterior minimally invasive transpedicular approach for giant calcified disc herniation. There were neither cases of neurological deterioration nor increased rate of dural tears. This technique is thus safe and could be recommended for treatment of this rare disease.

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.

Mini–Open Retropleural Transthoracic Approach for the Treatment of Giant Thoracic Disc Herniation

Spine ◽  
2012 ◽  
Vol 37 (17) ◽  
pp. E1079-E1084 ◽  
Author(s):  
Catherine Moran ◽  
Zulfiqar Ali ◽  
Linda McEvoy ◽  
Ciaran Bolger
Keyword(s):  
Disc Herniation ◽  
Thoracic Disc Herniation ◽  
Transthoracic Approach ◽  
Thoracic Disc ◽  
Mini Open

scholarly journals Outpatient endoscopic resection of large calcified thoracic disc herniation with caudal displacement

2022 ◽  
Vol 6 (1) ◽  
pp. V18
Keyword(s):  
Spinal Cord ◽  
Intensive Care ◽  
Minimally Invasive ◽  
Endoscopic Approach ◽  
Tube Placement ◽  
Thoracic Disc Herniation ◽  
Intensive Care Admission ◽  
Chest Tube Placement ◽  
Disc Herniations ◽  
Thoracic Disc

Thoracic disc herniations can cause radiculopathy and myelopathy from neural compression. Surgical resection may require complex, morbid approaches. To avoid spinal cord retraction, wide exposures requiring extensive tissue, muscle, and bony disruption are needed, which may require instrumentation. Anterior approaches may require vascular surgeons, chest tube placement, and intensive care admission. Large, calcified discs or migrated fragments can pose additional challenges. Previous literature has noted the endoscopic approach to be contraindicated for calcified thoracic discs. The authors describe an ultra–minimally invasive, ambulatory endoscopic approach to resect a large calcified thoracic disc with caudal migration and avoidance of conventional approaches. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID2112

scholarly journals Minimally Invasive Lateral Approach for Anterior Spinal Cord Decompression in Thoracic Myelopathy

2021 ◽  
Author(s):  
Edna E. Gouveia ◽  
Mansour Mathkour ◽  
Erin McCormack ◽  
Jonathan Riffle ◽  
Olawale A. Sulaiman ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Disc Herniation ◽  
Interbody Fusion ◽  
Case Series ◽  
Lateral Approach ◽  
Spinal Instability ◽  
Decompression Procedure ◽  
Thoracic Disc ◽  
Mini Open

Myelopathy can result from a thoracic disc herniation (TDH) compressing the anterior spinal cord. Disc calcification and difficulty in accessing the anterior spinal cord pose an operative challenge. A mini-open lateral approach to directly decompress the anterior spinal cord can be performed with or without concomitant interbody fusion depending on pre-existing or iatrogenic spinal instability. Experience using stand-alone expandable spacers to achieve interbody fusion in this setting is limited. Technical advantages, risks and limitations of this technique are discussed. We conducted a retrospective chart review of all patients with thoracic and upper lumbar myelopathy treated with a lateral mini-open lateral approach. Review of the literature identified 6 other case series using similar lateral minimally invasive approaches to treat thoracic or upper lumbar disc herniation showing efficient and safe thoracic disc decompression procedure for myelopathy. This technique can be combined with interbody arthrodesis when instability is suspected.

Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique

2000 ◽  
Vol 9 (4) ◽  
pp. 1-7 ◽  
Author(s):  
Timothy G. Burke ◽  
Anthony J. Caputy
Keyword(s):  
Patient Outcome ◽  
Minimally Invasive ◽  
Disc Herniation ◽  
Significant Risk ◽  
Historical Evolution ◽  
Thoracic Disc Herniation ◽  
Traditional Methods ◽  
Thoracic Disc ◽  
Thoracoscopic Technique

Thoracic disc herniation has always carried with it the potential for serious adverse neurological consequences if not treated appropriately. The authors review the historical evolution of treatment for thoracic disc herniation from the early surgical series using dorsal approaches (which were known to involve a significant risk of paraplegia) to later surgical series in which lateral and then ventral approaches to the disc were increasingly emphasized, with significant improvement in patient outcome. The evolution of minimally invasive thoracoscopic techniques is discussed, together with the results of several surgical series demonstrating significant reductions in morbidity compared with more traditional methods. The technique of thoracoscopic discectomy is presented in detail.

Thoracic microendoscopic discectomy

2004 ◽  
Vol 1 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Mick J. Perez-Cruet ◽  
Bong-Soo Kim ◽  
Faheem Sandhu ◽  
Dino Samartzis ◽  
Richard G. Fessler
Keyword(s):  
Minimally Invasive ◽  
Disc Herniation ◽  
Thoracic Disc Herniation ◽  
Tubular Retractor ◽  
Content Type ◽  
Estimated Blood Loss ◽  
Disc Herniations ◽  
Microendoscopic Discectomy ◽  
Thoracic Disc ◽  
Fine Print

Object. Various approaches exist for the treatment of thoracic disc herniation. Anterior approaches facilitate ventral exposure but place the intrathoracic contents at risk. Posterolateral approaches require extensive muscle dissection that adds to the risk of postoperative morbidity. The authors have developed a novel posterolateral, minimally invasive thoracic microendoscopic discectomy (TMED) technique that provides an approach to the thoracic spine which is associated with less morbidity. Methods. Seven patients 23 to 54 years old with nine disc herniations underwent TMED. All lesions were soft lateral or midline thoracic disc herniations. Under fluoroscopic guidance with the patient positioned prone, the authors used a muscle dilation approach and the procedure was performed with endoscopic visualization through a tubular retractor. Based on a modified Prolo Scale, five patients experienced excellent results, one good, and one fair. No case required conversion to an open procedure. The mean operative time was 1.7 hours per level, and estimated blood loss was 111 ml per level. Hospital stays were short, and no complications occurred. Conclusions. The TMED is safe, effective, and provides a minimally invasive posterolateral alternative for treatment of thoracic disc herniation without the morbidity associated with traditional approaches.

Endoscope-assisted minimally invasive transforaminal thoracic interbody fusion

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video11
Author(s):  
Chih-Hsiang Liao ◽  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
Wei-Hsin Wang ◽  
Peng-Yuan Chang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Disc Herniation ◽  
Interbody Fusion ◽  
Herniated Disc ◽  
Thoracic Disc Herniation ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Lengths Of Stay ◽  
Transpedicular Approach ◽  
Thoracic Disc

Surgical treatment of thoracic disc herniation is technically challenging from anterior, lateral or posterior approaches. Because of the deeply located thoracic discs and non-retractable thoracic thecal sac, standard anterior and lateral procedures for discectomy require extensive tissue dissection causing prolonged lengths of stay in hospital. In this video, the authors present a case of calcified disc herniation at the level of T10/11 causing paraplegia and voiding difficulty. The patient was operated on via an endoscope-assisted minimally invasive transforaminal thoracic interbody fusion (EA-TTIF). The herniated disc and calcification were removed through a 26-mm tubular retractor, under microscopes via a unilateral transpedicular approach. The endoscopes were used for direct visualization of the ventral thecal sac and confirmation of complete decompression. After the operation, the patient's neurological function completely recovered. Minimally invasive EA-TTIF is a viable and effective option for the surgical management of thoracic disc herniation. Thoracic interbody fusion can be achieved through a minimally invasive approach from the back.The video can be found here: http://youtu.be/54rRMtvSyCM.

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