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.

Spontaneous intracranial hypotension due to thoracic disc herniation

2002 ◽  
Vol 96 (3) ◽  
pp. 343-345 ◽  
Author(s):  
Stuart C. A. Winter ◽  
Nicholas F. Maartens ◽  
Philip Anslow ◽  
Peter J. Teddy
Keyword(s):  
Disc Herniation ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Herniated Disc ◽  
Subdural Effusion ◽  
Thoracic Disc Herniation ◽  
Content Type ◽  
Blood Patch ◽  
Thoracic Disc ◽  
Fine Print

✓ Spontaneous intracranial hypotension is frequently idiopathic. The authors report on a patient presenting with symptomatic intracranial hypotension caused by a transdural calcified thoracic disc herniation. Cranial magnetic resonance (MR) imaging revealed classic signs of intracranial hypotension, and a combination of spinal MR and computerized tomography myelography confirmed a mid-thoracic transdural calcified herniated disc as the cause. The patient was treated with an epidural blood patch and burr hole drainage of the subdural effusion on two occasions. Postoperatively the headache resolved and there was no neurological deficit. Thoracic disc herniation may be a cause of spontaneous intracranial hypotension.

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.

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.

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

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.

scholarly journals Modified arthroscopic Broström procedure using a soft anchor for chronic lateral ankle instability: Short-term follow-up results

2021 ◽  
Author(s):  
Ramin Moradi ◽  
Bertan Cengiz
Keyword(s):  
Postoperative Period ◽  
Ankle Instability ◽  
Functional Improvement ◽  
Invasive Technique ◽  
Return To Sports ◽  
Complication Rates ◽  
Short Term ◽  
The Mean ◽  
Ankle Function

Objectives: This study aims to examine the clinical outcomes and complications of lateral ligament reconstruction performed using soft anchors according to the arthroscopic modified Broström technique (MBT) for the treatment of chronic ankle instability (CAI) and to evaluate the frequency of return to sports. Patients and methods: A total of 14 patients with CAI (9 males, 5 females; mean age: 30.1±4.6 years; range, 22 to 38 years) who underwent the MBT with soft anchors between January 2015 and December 2019 were retrospectively analyzed. Ankle function was evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale and Karlsson Ankle Function Score (Karlsson/Peterson, K/D score), while pain was evaluated using the Visual Analog Scale (VAS) after a minimum follow-up of 12 months. Results: The mean follow-up was 23.6±7.7 months. The mean overall AOFAS score was 74.0±2.6 preoperatively, which improved to 96.2±1.9 in the postoperative period (p=0.001). The mean pre- and postoperative K/P scores were 72.4±3.1 (range, 68 to 78) and 95.3±2.2 (range, 92 to 98), respectively (p=0.001). The mean preoperative VAS score was 2.4±0.9 (range, 1 to 4) and showed a significant improvement to 0.6±0.5 (range, 0 to 1) in the postoperative period (p=0.001). Nine patients (64.3%) returned to sports activities after surgery at a mean period of 9±2.1 months. Conclusion: In the treatment of CAI, arthroscopic MBT performed with soft anchors provides successful outcomes in short-term follow-up. In addition to being a minimally invasive technique, MBT is a reliable and safe approach with low complication rates and significant functional improvement. However, the low ratio of return to sports should be considered as a failure of this technique.

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 < 0.001) and 2.56 mJOA score respectively (P < 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.

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.

Thoracic Disc Herniation

2018 ◽  
pp. 109-122
Author(s):  
Derrick Umansky ◽  
James Kalyvas
Keyword(s):  
Health Status ◽  
Disc Herniation ◽  
Treatment Options ◽  
Radicular Pain ◽  
Surgical Approaches ◽  
Thoracic Disc Herniation ◽  
Thoracic Myelopathy ◽  
Thoracic Disc ◽  
Disc Size ◽  
Overall Health Status

Consensus in the literature supports surgery for severely symptomatic or disabling thoracic disc herniation only, with all others requiring observation or non-surgical intervention. For those patients requiring surgery, there are a variety of approaches that are used depending on symptomatology, spinal level, disc size, disc location relative to the canal and to the neural elements, presence of calcification, and overall health status of the patient. Dorsolateral/lateral approaches include transpedicular, transfacet pedicle-sparing, costotransversectomy, extracavitary, and parascapular; ventrolateral approaches include transthoracic thoracotomy, transthoracic thoracoscopy, and retropleural thoracotomy; finally, ventral approaches include transsternal and manubrial window. Thoracic myelopathy has a broad differential diagnosis. The cause of which can be identified with a detailed history, physical exam, and properly selected imaging. In the following chapter, we discuss herniated thoracic discs (HTD) including the common presentations, imaging findings, and the surgical treatment options. Consensus in the literature supports surgical management for HTDs that are severely symptomatic and disabling. The surgical approaches depends on the spine level, disc size, disc location, presence of calcification, and overall health status of the patient. The improvement rate for myelopathic patients ranges from 71% to 97% and for back pain and radicular pain from 67% to 94%. The overall complication rate is approximately 15%.

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