scholarly journals Reoperation for herniated thoracic discs

1999 ◽  
Vol 6 (5) ◽  
pp. E7
Author(s):  
Curtis A. Dickman ◽  
Daniel Rosenthal ◽  
John J. Regan
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Herniated Disc ◽  
Disc Disease ◽  
Initial Surgery ◽  
Cord Injury ◽  
Disc Herniations ◽  
Thoracic Discectomy ◽  
Thoracic Disc

In this review the authors address the surgical strategies required to resect residual thoracic disc herniations. Fifteen patients who had undergone prior thoracic discectomy and who harbored residual or incompletely excised symptomatic thoracic discs were reviewed retrospectively. The surgical procedures that had failed to excise the herniated discs completely included 11 posterolateral approaches, one thoracotomy, and three thoracoscopic procedures. Of the incompletely resected or residual disks 13 were central calcified, two were soft, 12 were extradural, and three were intradural discs. Indications for reoperation were often multiple in each patient and included misidentification of the level of disc disease at the initial operation (five cases), abandoning the procedure because of intraoperative spinal cord injury (three cases), inadequate visualization of the pathology (eight cases), migration of a soft disc fragment within the spinal canal (one case), and intradural disc extension (three cases). The symptoms at the time of reoperation included myelopathy in 13 patients and radicular pain in two. The mean interval before reoperation was 150 days (range 1 day-4 years). The reoperation procedures included one thoracotomy and 14 video-assisted thoracoscopic procedures performed ipsilateral (11 cases) or contralateral (four cases) to the site of the initial surgery. The herniated disc material was excised completely in all 15 cases without causing new neurological deficits. Reoperation complications included atelectasis in three patients, intercostal neuralgia in two, a loosened screw that required removal in one, and a cerebrospinal fluid leak in one patient. Of the 13 patients who experienced myelopathy preoperatively, 10 recovered neurological function and three stabilized. All patients with radicular pain improved. Calcified, large, broad-based, centrally located, or transdural thoracic disc herniations can be difficult to resect. These lesions require a ventral operative approach to visualize the dura adequately for a safe and complete resection.

Reoperation for herniated thoracic discs

1999 ◽  
Vol 91 (2) ◽  
pp. 157-162 ◽  
Author(s):  
Curtis A. Dickman ◽  
Daniel Rosenthal ◽  
John J. Regan
Keyword(s):  
Surgical Procedures ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Herniated Disc ◽  
Disc Disease ◽  
Content Type ◽  
Initial Surgery ◽  
Cord Injury ◽  
Intradural Disc Herniation ◽  
Fine Print

Object. In this review the authors address the surgical strategies required to resect residual herniated thoracic discs. Methods. Data obtained in 15 patients who had undergone prior thoracic discectomy and who harbored residual or incompletely excised symptomatic thoracic discs were reviewed retrospectively. The surgical procedures that had failed to excise the herniated discs completely included 11 posterolateral approaches, one thoracotomy, and three thoracoscopyguided surgical procedures. Of the lesions that were incompletely resected or residual, there were 13 central calcified, two soft, 12 extradural, and three intradural discs. Indications for reoperation were often multiple in each patient and included misidentification of the level of disc disease at the initial operation (five cases), abandoning the procedure because of intraoperative spinal cord injury (three cases), inadequate visualization of the pathological entity (eight cases), migration of a soft disc fragment within the spinal canal (one case), and intradural disc extension (three cases). The symptoms at the time of reoperation included myelopathy in 13 patients and radicular pain in two patients. The mean interval before reoperation was 150 days (range 1 day–4 years). The reoperation procedures included one thoracotomy and 14 video-assisted thoracoscopic procedures performed ipsilateral (11 cases) or contralateral (four cases) to the site of the initial surgery. The herniated disc material was excised completely in all 15 cases without causing new neurological deficits. Reoperation complications included atelectasis in three patients, intercostal neuralgia in two, a loosened screw that required removal in one, residual intradural disc herniation that required a second reoperation in one patient, and a cerebrospinal fluid leak in one patient. Of the 13 patients who experienced myelopathy prior to operation, 10 recovered neurological function and three stabilized. All patients with radicular pain improved. Conclusions. Calcified, large, broad-based, centrally located, or transdural thoracic disc herniations can be difficult to resect. These lesions require a ventral operative approach to visualize the dura adequately for a safe and complete resection.

Anterior Lumbar Microdiscectomy and Interbody Fusion for the Treatment of Recurrent Disc Herniation

Neurosurgery ◽  
2001 ◽  
Vol 48 (2) ◽  
pp. 334-338 ◽  
Author(s):  
A. Giancarlo Vishteh ◽  
Curtis A. Dickman
Keyword(s):  
Interbody Fusion ◽  
Lumbar Disc ◽  
Posterior Longitudinal Ligament ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Herniated Disc ◽  
X Rays ◽  
Lumbar Microdiscectomy ◽  
Disc Herniations

Abstract OBJECTIVE To demonstrate the feasibility of anterior lumbar microdiscectomy in patients with recurrent, sequestered lumbar disc herniations. METHODS Between 1997 and 1999, six patients underwent a muscle-sparing “minilaparotomy” approach and subsequent microscopic anterior lumbar microdiscectomy and fragmentectomy for recurrent lumbar disc extrusions at L5–S1 (n = 4) or L4–L5 (n = 2). A contralateral distraction plug permitted ipsilateral discectomy under microscopic magnification. Effective resection of the extruded disc fragments was accomplished by opening the posterior longitudinal ligament. Interbody fusion was performed by placing cylindrical threaded titanium cages (n = 4) or threaded allograft bone dowels (n = 2). RESULTS There were no complications, and blood loss was minimal. Follow-up magnetic resonance imaging revealed complete resection of all herniated disc material. Plain x-rays revealed excellent interbody cage position. Radicular pain and neurological deficits resolved in all six patients (mean follow-up, 14 mo). CONCLUSION Anterior lumbar microdiscectomy with interbody fusion provides a viable alternative for the treatment of recurrent lumbar disc herniations. Recurrent herniated disc fragments can be removed completely under direct microscopic visualization, and interbody fusion can be performed in the same setting.

Surgery for thoracic disc disease. Complication avoidance: overview and management

2000 ◽  
Vol 9 (4) ◽  
pp. 1-6 ◽  
Author(s):  
William E. McCormick ◽  
Steven F. Will ◽  
Edward C. Benzel
Keyword(s):  
Pulmonary Embolism ◽  
Vertebral Column ◽  
Cerebrospinal Fluid Leak ◽  
Surgical Approaches ◽  
Disc Disease ◽  
Medline Search ◽  
Intercostal Neuralgia ◽  
Thoracic Discectomy ◽  
Thoracic Disc ◽  
Fluid Leak

The operative approach for discectomy in the treatment of thoracic disc disease has changed from standard laminectomy to a variety of dorsolateral and ventral approaches. The procedure-related complications have been reported in numerous clinical studies over the last seven decades: death, neurological deterioration, postoperative vertebral column instability, incomplete disc resection, cerebrospinal fluid leak and fistula, infection, misdiagnosis, pulmonary embolism, pneumonia, and intercostal neuralgia. The authors conducted a Medline search to identify series reporting clinical data related to thoracic discectomy. They analyzed the morbidity and mortality resulting from the various surgical approaches for thoracic disc disease, with special attention to the avoidance and management of surgery-related complications.

Surgical management of multiple thoracic disc herniations via a transfacet approach: a report of 15 cases

2011 ◽  
Vol 15 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Paul M. Arnold ◽  
Philip L. Johnson ◽  
Karen K. Anderson
Keyword(s):  
Radicular Pain ◽  
Sensory Loss ◽  
Herniated Disc ◽  
Posterior Fixation ◽  
Preoperative Pain ◽  
Average Patient ◽  
Disc Herniations ◽  
Thoracic Disc ◽  
Herniated Discs

Object Symptomatic thoracic disc herniations (TDHs) are rare, and multiple TDHs account for an even smaller percentage of symptomatic herniated discs. Most TDHs are found in the lower thoracic spine, with more than 75% occurring below T-8. The authors report a series of 15 patients with multiple symptomatic TDHs treated with a modified transfacet approach. Methods Fifteen patients (9 women and 6 men) with a total of 32 symptomatic TDHs were treated surgically at the authors' institution between 1994 and 2010. The average patient age was 51.1 years. Thirteen patients had 2-level herniation and 2 patients had 3-level disease. The most commonly involved level was T7–8 (10 herniations), followed by T6–7 and T8–9 (6 herniations each). All patients had long-standing myelopathic and/or radicular complaints at the time of presentation. Each disc that exhibited radiographically confirmed compression of the spinal cord or nerve root was considered for resection. Only patients with lateral disc herniations were considered for the modified transfacet approach; patients with a centrally herniated disc underwent ventral or ventral-lateral procedures. The average follow-up time was 30 months. Results All patients had successful resection of their herniated discs. All patients with preoperative weakness demonstrated improved strength, and 11 of 12 patients with preoperative pain showed improvement in pain. Sensory loss was less consistently improved. The 2 patients who underwent posterior fixation and fusion achieved radiographically confirmed fusion by the 1-year follow-up. Nine of 10 patients who were working returned to their jobs. Eleven of 12 patients with preoperative back or radicular pain had drastic or complete pain resolution; 1 patient had no change in pain. All 7 patients with preoperative ambulatory difficulty had postoperative gait improvement. Complications were minimal. Conclusions Multiple symptomatic herniated thoracic discs are rare causes of pain and disability, but should be treated surgically because good outcomes can be achieved with acceptably low morbidity.

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.

The transfacet pedicle-sparing approach for thoracic disc removal: cadaveric morphometric analysis and preliminary clinical experience

1998 ◽  
Vol 4 (2) ◽  
pp. E8
Author(s):  
Charles B. Stillerman ◽  
Thomas C. Chen ◽  
J. Diaz Day ◽  
William T. Couldwell ◽  
Martin H. Weiss
Keyword(s):  
Operative Time ◽  
Spinal Column ◽  
Radicular Pain ◽  
Minimal Amount ◽  
Morphometric Measurements ◽  
Soft Tissue Dissection ◽  
Disc Herniations ◽  
Axial Pain ◽  
Thoracic Disc ◽  
Ventral Canal

A number of operative techniques have been described for the treatment of herniated thoracic discs. The transfacet pedicle-sparing approach allows for complete disc removal with limited spinal column disruption and soft-tissue dissection. Fifteen cadaveric spinal columns were used for evaluation of exposure, development of thoracic microdiscectomy instrumentation, and establishment of morphometric measurements. This approach was used to remove eight thoracic discs in six patients. Levels of herniation ranged from T-7 through T-11. Preoperatively, all patients had moderate to severe axial pain, and three (50%) of the six had radicular pain. Myelopathy was present in four (67%) of the six patients. Through a 4-cm opening, the ipsilateral paraspinal muscles were reflected, and a partial facetectomy was performed. The disc was then removed using specially designed microscopic instrumentation. Postoperatively, the radiculopathy resolved in all patients. Axial pain and myelopathy were completely resolved or significantly improved in all patients. The minimal amount of bone resection and muscle dissection involved in the operation allows for: 1) decreased operative time and blood loss; 2) diminished perioperative pain; 3) shorter hospitalization time and faster return to premorbid activity; 4) avoidance of closed chest tube drainage; and 5) preservation of the integrity of the facet-pedicle complex, with potential for improvement in outcome related to axial pain. This technique appears best suited for the removal of all centrolateral discs, although it has been used successfully for treating a disc occupying nearly the entire ventral canal. The initial experience suggests that this approach may be used to safely remove appropriately selected thoracic disc herniations with good results.

The pathophysiology of thoracic disc disease

2000 ◽  
Vol 9 (4) ◽  
pp. 1-8 ◽  
Author(s):  
James Mcinerney ◽  
Perry A. Ball
Keyword(s):  
Nucleus Pulposus ◽  
Thoracic Spine ◽  
Clinical Decision Making ◽  
Weight Bearing ◽  
Treatment Strategies ◽  
Signs And Symptoms ◽  
Science Data ◽  
Disc Disease ◽  
Disc Herniations ◽  
Thoracic Disc

Nucleus pulposus herniations are far less common in the thoracic spine than at the cervical and lumbar regions. Traditionally, diagnosis of thoracic disc herniations has been challenging because the signs and symptoms are often subtle early in their course. As a result, delays in diagnoses are common. Because they are uncommon as well as difficult to diagnosis, the neurosurgical community has sparse data on which to base good clinical decision making for the treatment of these herniations. In this review the authors seek to place the phenomenon of thoracic disc disease into the context of its pathophysiology. After a careful evaluation of the available clinical, pathological, and basic science data, a case is made that the cause of nucleus pulposus herniations in the thoracic spine is similar to those occurring in the lumbar and cervical regions. The lower incidence of herniations is ascribed primarily to the reduced allowable flexion at the thoracic level compared with the lumbar and cervical levels. To a lesser extent, the contribution of the ribs to weight-bearing may also play a role. Further review of clinical data suggests that thoracic disc herniations, like herniated cervical and lumbar discs, may be asymptomatic and may respond to conservative therapy. Similarly, good surgery-related results have been reported for herniated thoracic discs, despite the more challenging nature of the surgical procedure. The authors conclude that treatment strategies for thoracic disc herniations may logically and appropriately follow those commonly used for the cervical and lumbar levels.

Transcostovertebral approach for thoracic disc herniations

2001 ◽  
Vol 94 (1) ◽  
pp. 38-44 ◽  
Author(s):  
Dzung H. Dinh ◽  
John Tompkins ◽  
Shawn B. Clark
Keyword(s):  
Blood Loss ◽  
Average Length ◽  
Operating Time ◽  
Radicular Pain ◽  
Sensory Loss ◽  
Content Type ◽  
Disc Herniations ◽  
Axial Pain ◽  
Thoracic Disc ◽  
Fine Print

Object. The authors describe a new posterolateral transcostovertebral approach for the removal of herniated thoracic discs. Methods. From January 1994 to January 2000, 28 thoracic discs in 22 patients were excised via a new transcostovertebral surgical approach. Seventeen patients (77%) presented with axial pain, 14 (64%) with radicular pain, 13 (59%) with myelopathy, eight (36%) with sensory loss, and 10 (45%) with genitourinary (GU) symptoms such as urinary hesitancy or incontinence. The affected discs were approached using a midline incision to gain access of the costovertebral junction. The surgical corridor was posterolateral; the costovertebral joint and lateral edge of the vertebral endplates were drilled to expose the lateral annulus. The ribs were preserved, obviating the need for insertion of a chest tube postoperatively. The average operating time per level was 200.5 minutes (range 90–360 minutes). The average blood loss was 231 ml (50–750 ml). The average length of stay was 3.8 days. Most patients were discharged home on postoperative Day 2 or 3. No patients were worse postoperatively. Improvement was demonstrated in 13 (76%) of 17 patients with axial pain, 11 (79%) of 14 patients with radicular pain, 11 (85%) of 13 patients with myelopathy, seven (88%) of eight patients with sensory loss, and six (60%) of 10 patients with GU symptoms. Conclusions. This procedure is well suited for any thoracic disc level and offers several advantages over the traditional costotransversectomy or transthoracic approaches: shorter operating time, less blood loss, less extensive soft-tissue and bone dissection, reduced postoperative pain, and shorter hospital stays.

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. 

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