Endoscopic Access to the Ventral Thoracic spine: PETD vs. Thoracoscopy

Symptomatic thoracic disc herniation (TDH) is estimated to afflict between 1 in 1,000 and 1 in 1,000,000 people; affecting men more frequently than women, with the highest incidence seen at 40-50 years of age. TDH occurs at all levels of the thoracic spine but 75% of cases occur below T8, with T11-T12 being the most common site due to spinal mobility and weakness of the posterior longitudinal ligament.Manipulation of the thoracic spinal cord through the conventional posterior approach has been associated with poor outcomes. A conventional posterior approach consisting of laminectomy, cord retraction, and disc removal was historically done to treat TDH but this causes spinal cord injury and irreversible paraplegia due to cord manipulation on the relatively rigid spinal cord.The anterior approach to the spine is also intimidating to the spine surgeon due to the unique anatomy of the thoracic spine. Conventional open approaches to the thoracic spine involve a thoracotomy, rib resection, and corpectomy to view the spinal cord anteriorly. This has been associated with perioperative morbidity due to surgical site pain, difficult/painful breathing, shoulder girdle dysfunction, and wound healing problems.In order to spare the patients suffering from these postoperative iatrogenic sequelae, the author presents two different minimally invasive approach techniques; percutaneous endoscopic thoracic discectomy (PETD) vs. thoracoscopy, each applied to a different indication or thoracic pathology, to gain an enough but safe access to the ventral thoracic spinal canal through minimized surgical damages without yielding a postsurgical morbidity.

Download Full-text

Effect of thoracic spinal cord injury on forelimb somatosensory evoked potential

Brain Research Bulletin ◽

10.1016/j.brainresbull.2021.05.005 ◽

2021 ◽

Author(s):

Angelo H. All ◽

Shiyu Luo ◽

Xiaogang Liu ◽

Hasan Al-Nashash

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Evoked Potential ◽

Somatosensory Evoked Potential ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Cord Injury

Download Full-text

The Histopathology of Severe Graded Compression in Lower Thoracic Spinal Cord Segment of Rat, Evaluated at Late Post-injury Phase

Cellular and Molecular Neurobiology ◽

10.1007/s10571-021-01139-7 ◽

2021 ◽

Author(s):

Fedorova Jana ◽

Kellerova Erika ◽

Bimbova Katarina ◽

Pavel Jaroslav

Keyword(s):

Spinal Cord ◽

Spontaneous Recovery ◽

Traumatic Injury ◽

Blue Dye ◽

Post Injury ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Severe Traumatic Injury ◽

Spinal Cord Segment ◽

Cord Injury

AbstractSpontaneous recovery of lost motor functions is relative fast in rodent models after inducing a very mild/moderate spinal cord injury (SCI), and this may complicate a reliable evaluation of the effectiveness of potential therapy. Therefore, a severe graded (30 g, 40 g and 50 g) weight-compression SCI at the Th9 spinal segment, involving an acute mechanical impact followed by 15 min of persistent compression, was studied in adult female Wistar rats. Functional parameters, such as spontaneous recovery of motor hind limb and bladder emptying function, and the presence of hematuria were evaluated within 28 days of the post-traumatic period. The disruption of the blood-spinal cord barrier, measured by extravasated Evans Blue dye, was examined 24 h after the SCI, when maximum permeability occurs. At the end of the survival period, the degradation of gray and white matter associated with the formation of cystic cavities, and quantitative changes of glial structural proteins, such as GFAP, and integral components of axonal architecture, such as neurofilaments and myelin basic protein, were evaluated in the lesioned area of the spinal cord. Based on these functional and histological parameters, and taking the animal’s welfare into account, the 40 g weight can be considered as an upper limit for severe traumatic injury in this compression model.

Download Full-text

Emergency decompression and stabilization of 1st thoracic spinal cord injury and sacral fracture in a Covid-19 patient: A case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.105670 ◽

2021 ◽

Vol 81 ◽

pp. 105670

Author(s):

Achmad Jadi Didy Surachman ◽

Yanuarso ◽

Danar Lukman Akbar

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Case Report ◽

Sacral Fracture ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Cord Injury

Download Full-text

Sonic Hedgehog modulates the inflammatory response and improves functional recovery after spinal cord injury in a thoracic contusion–compression model

European Spine Journal ◽

10.1007/s00586-021-06796-2 ◽

2021 ◽

Author(s):

Hao Zhang ◽

Alexander Younsi ◽

Guoli Zheng ◽

Mohamed Tail ◽

Anna-Kathrin Harms ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Sonic Hedgehog ◽

Functional Recovery ◽

Intrathecal Administration ◽

Neuroprotective Effects ◽

Thoracic Spinal Cord ◽

Shh Pathway ◽

Thoracic Spinal ◽

Cord Injury

Abstract Purpose The Sonic Hedgehog (Shh) pathway has been associated with a protective role after injury to the central nervous system (CNS). We, therefore, investigated the effects of intrathecal Shh-administration in the subacute phase after thoracic spinal cord injury (SCI) on secondary injury processes in rats. Methods Twenty-one Wistar rats were subjected to thoracic clip-contusion/compression SCI at T9. Animals were randomized into three treatment groups (Shh, Vehicle, Sham). Seven days after SCI, osmotic pumps were implanted for seven-day continuous intrathecal administration of Shh. Basso, Beattie and Bresnahan (BBB) score, Gridwalk test and bodyweight were weekly assessed. Animals were sacrificed six weeks after SCI and immunohistological analyses were conducted. The results were compared between groups and statistical analysis was performed (p < 0.05 was considered significant). Results The intrathecal administration of Shh led to significantly increased polarization of macrophages toward the anti-inflammatory M2-phenotype, significantly decreased T-lymphocytic invasion and significantly reduced resident microglia six weeks after the injury. Reactive astrogliosis was also significantly reduced while changes in size of the posttraumatic cyst as well as the overall macrophagic infiltration, although reduced, remained insignificant. Finally, with the administration of Shh, gain of bodyweight (216.6 ± 3.65 g vs. 230.4 ± 5.477 g; p = 0.0111) and BBB score (8.2 ± 0.2 vs. 5.9 ± 0.7 points; p = 0.0365) were significantly improved compared to untreated animals six weeks after SCI as well. Conclusion Intrathecal Shh-administration showed neuroprotective effects with attenuated neuroinflammation, reduced astrogliosis and improved functional recovery six weeks after severe contusion/compression SCI.

Download Full-text

Disseminated Cryptococcosis revealed by transverse myelitis in Immunocompetent patient: a case report and review of the literature

BMC Neurology ◽

10.1186/s12883-020-1598-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Fangfang Qu ◽

Zhenzhen Qu ◽

Yingqian Lv ◽

Bo Song ◽

Bailin Wu

Keyword(s):

Spinal Cord ◽

Amphotericin B ◽

Transverse Myelitis ◽

Immunocompetent Patient ◽

Lower Limbs ◽

Coxsackie Virus ◽

Gadolinium Contrast ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Cord Injury

Abstract Background Transverse myelitis (TM) is due to inflammatory spinal cord injury with bilateral neurologic involvement, which is sensory, motor, or autonomic in nature. It may be associated with autoimmune disease, vaccination, intoxication and infections. The most common infection cause of TM is Coxsackie virus and Mycoplasma pneumoniae. The cryptococcosis is rare. We present the case of disseminated cryptococcosis revealed by transverse myelitis in an immunocompetent 55-year-old male patient. The literature review is also stated. Case presentation The 55-year-old man suffered from gradual numbness, weakness in both lower limbs and finally paralyzed in the bed. The thoracic spine Computed tomography (CT) was normal, but multiple nodules in the lung were accidentally discovered. Thoracic Magnetic Resonance Imaging (MRI) showed diffused thoracic spinal cord thickening and extensively intramedullary T2 hyper intensity areas. Gadolinium contrast enhanced T1WI showed an intramedullary circle-enhanced nodule at 9th thoracic level. Diagnosis was made by histological examination of the bilateral lung biopsy. The patient was treated successfully with systemic amphotericin B liposome and fluconazole and intrathecal dexamethasone and amphotericin B liposome. Conclusions This is a patient with disseminated cryptococcosis involving the lung, spinal cord and adrenal glands, which is rare in the absence of immunodeficiency.

Download Full-text

Transdural herniation of the thoracic spinal cord: untethering via a posterolateral transpedicular approach

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.1.2.0223 ◽

2004 ◽

Vol 1 (2) ◽

pp. 223-227 ◽

Cited By ~ 20

Author(s):

Ryder Gwinn ◽

Fraser Henderson

Keyword(s):

Spinal Cord ◽

Posterior Approach ◽

Thoracic Spinal Cord ◽

Dural Repair ◽

Content Type ◽

Transpedicular Approach ◽

Thoracic Spinal ◽

Novel Approach ◽

Spinal Cord Herniation ◽

Thoracic Cord

✓ Anterior spinal cord herniation is a well-documented condition in which the thoracic cord becomes tethered within a defect in the anterior dura mater. Typical procedures have involved a posterior approach with direct manipulation of the thoracic cord to expose and blindly release its point of tethering. The authors report three cases in which a novel approach for the treatment of anterior thoracic cord herniation was performed, cord manipulation and traction are minimized, and direct dural repair of the defect is performed.

Download Full-text