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.

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.

scholarly journals Posterior thoracic laminoplasty with dorsal, intradural identification of ventral defect and transdural discectomy for a spontaneous cerebrospinal fluid leak: case report

2015 ◽  
Vol 22 (5) ◽  
pp. 478-482 ◽  
Author(s):  
Katie Pricola Fehnel ◽  
Lawrence F. Borges
Keyword(s):  
Motor Evoked Potentials ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Dural Defect ◽  
Contrast Extravasation ◽  
Blood Patch ◽  
Surgeon Experience ◽  
Posterior Laminectomy ◽  
Thoracic Disc ◽  
Fluid Leak

Spontaneous intracranial hypotension (SIH) has been increasingly reported in the literature concomitant with the improved sensitivity of imaging modalities. Although typically associated with meningeal weakening, a handful of cases of SIH secondary to thoracic disc osteophytes have been reported. Five of 7 reported cases were treated with epidural blood patch (EBP) alone while 2 required surgical management. There is no standard operative approach; both anterior and posterolateral approaches can be cumbersome and associated with morbidity, particularly in young, healthy patients. The authors report a case of SIH in which a ventral dural tear secondary to a calcified thoracic disc was repaired via posterior thoracic laminoplasty with dorsal durotomy and intradural exposure of the ventral defect with transdural discectomy followed by primary closure. A 34-year-old man presented with low-pressure headaches following axial load injury from a ski accident 5 years earlier. The patient's symptoms were refractory to a trial of conservative treatment and EBP, and he developed bilateral upper-extremity paresthesias. MRI of the spine demonstrated an extrathecal collection spanning the thoracic spine, and dynamic CT myelography identified contrast extravasation adjacent to a calcified paramedian disc at T9–10. The patient underwent posterior laminoplasty with neuromonitoring. A ventral dural defect was visualized via a dorsal durotomy, the penetrating disc osteophyte was removed transdurally, and the ventral and dorsal dura maters were closed primarily. Both somatosensory and motor evoked potentials were unchanged during surgery. The patient has remained asymptomatic more than 10 months postoperatively and he has resumed work as a surgeon. Cases of SIH secondary to a calcified thoracic disc are rare with little precedent as to optimal surgical intervention. This case illustrates the potential usefulness of posterior laminectomy in nonmyelopathic patients in whom there is no evidence of canal compromise and for whom neuromonitoring is available. Additionally, surgeon experience and patient preference may guide surgical planning.

scholarly journals Biomechanics of thoracic discectomy

2001 ◽  
Vol 11 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Andrew E. Wakefield ◽  
Michael P. Steinmetz ◽  
Edward C. Benzel
Keyword(s):  
Decision Making ◽  
Management Strategies ◽  
Surgical Approaches ◽  
Decision Making Process ◽  
Thoracic Disc Herniation ◽  
Unique Region ◽  
Surgical Decision ◽  
Thoracic Discectomy ◽  
Thoracic Disc ◽  
Surgical Decision Making

The thoracic spine is a structurally unique region that renders it uniquely suceptible to thoracic disc herniation. Surgical management strategies are complicated, in part, by the regional anatomical and biomechanical nuances. Surgical approaches include posterior, posterolateral, and anterior routes. Each isassociated with specific indications and contraindications. The biomechanical principles and safe anatomical trajectories must be considered in the surgical decision-making process. These issues are discussed in the pages that follow.

Cerebrospinal Fluid Leak Risk Factors in Pediatric Patients undergoing Endoscopic Endonasal Skull Base Surgery

2015 ◽  
Vol 76 (S 01) ◽  
Author(s):  
Amanda Stapleton ◽  
Elizabeth Tyler-Kabara ◽  
Paul Gardner ◽  
Snyderman Carl ◽  
Wang Eric
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Pediatric Patients ◽  
Skull Base Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Endoscopic Endonasal ◽  
Fluid Leak

Endoscopic Management of the Cerebrospinal Fluid Leak

Skull Base ◽  
2009 ◽  
Vol 19 (S 02) ◽  
Author(s):  
E. Pasquini ◽  
G. Tenti ◽  
C. Bordonaro ◽  
P. Farneti ◽  
V. Sciarretta ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Endoscopic Management ◽  
Fluid Leak

Risk factor for cerebrospinal fluid leak after endoscopic endonasal skull base surgery: a single-center experience

2021 ◽  
pp. 1-5
Author(s):  
Hiroyuki Ozawa ◽  
Mariko Sekimizu ◽  
Shin Saito ◽  
Shintaro Nakamura ◽  
Takuya Mikoshiba ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Risk Factor ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Single Center ◽  
Endoscopic Endonasal ◽  
Single Center Experience ◽  
Fluid Leak

Technical Nuances in Neuroendoscopic Lavage for Germinal Matrix Hemorrhage in Preterm Infants: Twenty Tips and Pearls after More than One Hundred Procedures

2021 ◽  
pp. 1-9
Author(s):  
Jorge Tirado-Caballero ◽  
Jorge Herreria-Franco ◽  
Mónica Rivero-Garvía ◽  
Gloria Moreno-Madueño ◽  
Maria Jose Mayorga-Buiza ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Cerebrospinal Fluid Leak ◽  
Tips And Tricks ◽  
Germinal Matrix ◽  
Suitable Alternative ◽  
Posthemorrhagic Hydrocephalus ◽  
Mortality And Morbidity ◽  
Germinal Matrix Hemorrhage ◽  
Preoperative Stage ◽  
Fluid Leak

<b><i>Introduction:</i></b> Posthemorrhagic hydrocephalus in preterm infants is a serious entity related to high mortality and morbidity. Neuroendoscopic lavage (NEL) is a suitable alternative for the management of this pathology. However, as with every endoscopic technique, it requires some experience and several cases to master. <b><i>Methods:</i></b> We present a descriptive study of some technical nuances, tips, and tricks that have been learned in the last 8 years with over a hundred NELs performed in preterm infants. These variations are classified into 3 categories according to their temporal relationship with the surgical procedure: preoperative stage, intraoperative stage, and postoperative stage. We include a brief description of each one and the reasons why they are included in our current clinical practice. <b><i>Results:</i></b> Twenty tips and pearls were described in detail and are reported here. Preoperative, intraoperative, and postoperative variations were exposed and related to the most frequent complications of this procedure: infection, cerebrospinal fluid leak, and rebleeding. <b><i>Conclusions:</i></b> NEL is a useful technique for the management of germinal matrix hemorrhage in preterm infants. These technical nuances have improved the results of our technique and helped us to prevent complications related to the procedure.

scholarly journals Crayon in the Orbit and Sinuses in a Pediatric Patient

2021 ◽  
pp. 014556132110185
Author(s):  
Michela Borrelli ◽  
Kristen A. Echanique ◽  
Jeffrey Koempel ◽  
Elisabeth H. Ference
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Pediatric Patient ◽  
Cerebrospinal Fluid Leak ◽  
Ethmoid Sinus ◽  
Rare Occurrence ◽  
Lamina Papyracea ◽  
The Right ◽  
Fluid Leak ◽  
Type Of Injury

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

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