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.

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.

scholarly journals Calcified giant thoracic disc herniations: considerations and treatment strategies

2014 ◽  
Vol 23 (S1) ◽  
pp. 76-83 ◽  
Author(s):  
N. A. Quraishi ◽  
A. Khurana ◽  
M. M. Tsegaye ◽  
B. M. Boszczyk ◽  
S. M. H. Mehdian
Keyword(s):  
Treatment Strategies ◽  
Disc Herniations ◽  
Thoracic Disc

scholarly journals The nucleus pulposus microenvironment in the intervertebral disc: the fountain of youth?

2021 ◽  
Vol 41 ◽  
pp. 707-738
Author(s):  
J , Guerrero ◽  
◽  
S Häckel ◽  
AS Croft ◽  
S Hoppe ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Intervertebral Disc ◽  
Nucleus Pulposus ◽  
Treatment Strategies ◽  
Disc Disease ◽  
Age Related ◽  
Key Factor ◽  
Fountain Of Youth ◽  
And Function ◽  
Ivd Degeneration

The intervertebral disc (IVD) is a complex tissue, and its degeneration remains a problem for patients, without significant improvement in treatment strategies. This mostly age-related disease predominantly affects the nucleus pulposus (NP), the central region of the IVD. The NP tissue, and especially its microenvironment, exhibit changes that may be involved at the outset or affect the progression of IVD pathology. The NP tissue microenvironment is unique and can be defined by a variety of specific factors and components characteristic of its physiology and function. NP progenitor cell interactions with their surrounding microenvironment may be a key factor for the regulation of cellular metabolism, phenotype, and stemness. Recently, celltransplantation approaches have been investigated for the treatment of degenerative disc disease, highlighting the need to better understand if and how transplanted cells can give rise to healthy NP tissue. Hence, understanding all the components of the NP microenvironment seems to be critical to better gauge the success and outcomes of approaches for tissue engineering and future clinical applications. Knowledge about the components of the NP microenvironment, how NP progenitor cells interact with them, and how changes in their surroundings can alter their function is summarised. Recent discoveries in NP tissue engineering linked to the microenvironment are also reviewed, meaning how crosstalk within the microenvironment can be adjusted to promote NP regeneration. Associated clinical problems are also considered, connecting bench-to-bedside in the context of IVD degeneration.

Thoracic spinal disease

2019 ◽  
pp. 711-718
Author(s):  
Kieron Sweeney ◽  
Catherine Moran ◽  
Ciaran Bolger
Keyword(s):  
Cervical Spine ◽  
Thoracic Spine ◽  
Osteoporotic Fractures ◽  
Biomechanical Properties ◽  
Minimally Invasive Techniques ◽  
Disc Prolapse ◽  
Disc Disease ◽  
Thoracic Spinal ◽  
Thoracic Disc ◽  
Invasive Techniques

The thoracic spine occupies a unique position with respect to anatomical, biomechanical, pathological, and surgical considerations. The kyphosis of the thoracic spine is offset by the lordosis in the mobile cervical spine and the principal load bearing lumbar spine maintaining a sagittal balanced posture. Due to the biomechanical properties of the thoracic spine, the incidence of thoracic disc prolapse is low. However, the anatomical features of the thoracic spine make appropriate surgical planning imperative. This chapter will cover the management and operative approaches to thoracic disc disease, including open and minimally invasive techniques. Operative approaches can be broadly divided into two groups, anterior and posterior-lateral. Each approach is discussed with respect to technique, anatomy, closure, and common complications. It will also discuss pathogenesis, diagnosis, and management of osteoporotic fractures.

scholarly journals ‘Benign Thoracic Pain’ Syndrome: Role of Magnetic Resonance Imaging in the Detection and Localization of Thoracic Disc Disease

1989 ◽  
Vol 82 (2) ◽  
pp. 81-83 ◽  
Author(s):  
F E Bruckner ◽  
A Greco ◽  
A W L Leung
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Intervertebral Disc ◽  
Thoracic Spine ◽  
Imaging Modality ◽  
Pain Syndrome ◽  
Resonance Imaging ◽  
Disc Disease ◽  
Thoracic Pain ◽  
Thoracic Disc

The syndrome of ‘benign thoracic pain’ is seen in young women who have pain and tenderness in the mid-thoracic spine radiating around the chest and aggravated by spinal movement. Ten consecutive patients with this syndrome and 15 controls were evaluated with magnetic resonance imaging (MRI). This showed thoracic intervertebral disc dehydration with no associated prolapse in 90% of the patients and 13% of the controls. We postulate that the clinical features are due to impaired shock absorption of these degenerate discs rather than direct compression of surrounding structures. MRI is non-invasive and does not use ionizing radiation; it allows direct visualization of the entire thoracic spine and cord, and accurate detection of early disc degeneration. Thus, it is the imaging modality of choice for defining the subtle intervertebral disc abnormalities that characterize the ‘benign thoracic pain’ syndrome.

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 Full-endoscopic uniportal decompression in disc herniations and stenosis of the thoracic spine using the interlaminar, extraforaminal, or transthoracic retropleural approach

2018 ◽  
Vol 29 (2) ◽  
pp. 157-168 ◽  
Author(s):  
Sebastian Ruetten ◽  
Patrick Hahn ◽  
Semih Oezdemir ◽  
Xenophon Baraliakos ◽  
Harry Merk ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Thoracic Spine ◽  
Surgical Techniques ◽  
Anatomical Location ◽  
Thoracic Disc Herniation ◽  
Advantages And Disadvantages ◽  
Canal Stenosis ◽  
Secondary Bleeding ◽  
Disc Herniations ◽  
Thoracic Disc

OBJECTIVESurgery for thoracic disc herniation and spinal canal stenosis is comparatively rare and often challenging. Individual planning and various surgical techniques and approaches are required. The key factors for selecting the technique and approach are anatomical location, consistency of the pathology, general condition of the patient, and the surgeon’s experience. The objective of the study was to evaluate the technical implementation and outcomes of a full-endoscopic uniportal technique via the interlaminar, extraforaminal, or transthoracic retropleural approach in patients with symptomatic disc herniation and stenosis of the thoracic spine, taking specific advantages and disadvantages and literature into consideration.METHODSBetween 2009 and 2015, decompression was performed in 55 patients with thoracic disc herniation or stenosis using a full-endoscopic uniportal technique via an interlaminar, extraforaminal, or transthoracic retropleural approach. Imaging and clinical data were collected during follow-up examinations for 18 months.RESULTSSufficient decompression was achieved in the full-endoscopic uniportal technique. One patient required revision due to secondary bleeding, and another exhibited persistent deterioration on myelopathy. No other serious complications were observed. All but one patient experienced regression or improvement of their symptoms.CONCLUSIONSThe full-endoscopic uniportal technique with an interlaminar, extraforaminal, or transthoracic retropleural approach was found to be a sufficient and minimally invasive method. To cover the entire range of thoracic disc herniations and stenosis within the criteria named, all full-endoscopic approaches are required.

scholarly journals Operation of Soft or Calcified Thoracic Disc Herniations in the Full-Endoscopic Uniportal Extraforaminal Technique

2018 ◽  
Vol 1 (21;1) ◽  
pp. E331-E340 ◽  
Author(s):  
Sebastian Ruetten
Keyword(s):  
Spinal Cord ◽  
Retrospective Study ◽  
Minimally Invasive ◽  
Disc Herniation ◽  
Thoracic Spine ◽  
Surgical Trauma ◽  
Thoracic Disc Herniation ◽  
Soft Or ◽  
Disc Herniations ◽  
Thoracic Disc

Background: Surgery for thoracic disc herniation and stenosis is comparatively rare and often demanding. The goal is to achieve sufficient decompression without manipulating the spinal cord and to minimize surgical trauma and its consequences. Individual planning and various surgical techniques and approaches are required. The key factors for selecting the technique are anatomical location, consistency of the pathology, general condition of the patient, and the surgeon’s experience. Objectives: The objective of the study was the evaluation of the technical implementation and outcomes of a full-endoscopic uniportal technique via the extraforaminal approach in patients with symptomatic soft or calcified disc herniation of the thoracic spine, taking specific advantages and disadvantages and literature into consideration. Study Design: Retrospective study Setting: A center for spine surgery and pain medicine. Methods: Between 2009 and 2015, decompression was performed on 26 patients with thoracic disc herniation or stenosis with radicular or myelopathic symptoms in a full-endoscopic uniportal technique with an extraforaminal approach. No patients underwent additional posterior stabilization. Imaging and clinical data were collected in follow-up examinations for 18 months. Results: Sufficient decompression was achieved in the full-endoscopic uniportal technique in all cases. The individual selection of the respective approach made it possible to reach the target area without manipulating the spinal cord. One patient experienced deterioration of a myelopathy. No other serious complications were observed. All patients, except one, experienced regression or improvement of symptoms. No evidence of increasing instability was found in imaging. Limitations: This is a retrospective study. The limited number of cases must be considered. Conclusions: The full-endoscopic uniportal technique with an extraforaminal approach was found to be a sufficient and minimally invasive method with the known advantages of an endoscopic procedure under continuous irrigation for monosegmental disc herniations. The inclusion criteria must be taken into consideration. If they are not met, an alternative full-endoscopic approach (interlaminar, transthoracic retropleural) or decompression in a conventional method must be selected. Additional stabilization does not appear to be necessary due to the low level of trauma. Key Words: Extraforaminal approach, thoracic disc herniation, giant disc herniation, Fullendoscopic, minimally invasive, thoracic spine

scholarly journals Retropleural thoracotomy

2001 ◽  
Vol 10 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Peter D. Angevine ◽  
Paul C. McCormick
Keyword(s):  
Postoperative Pain ◽  
Clinical Outcomes ◽  
Thoracic Spine ◽  
Anterior Approach ◽  
Anterolateral Approach ◽  
Disc Disease ◽  
Chest Drainage ◽  
Surgical Field ◽  
Thoracic Disc ◽  
Traditional Approaches

Herniated thoracic discs, unlike their lumbar counterparts, are difficult to read and safely resect using traditional posterior approaches. Historically, the use of a laminectomy for thoracic disc resection has yielded poor clinical outcomes. Posterolateral and anterolateral approaches have become the standard surgical means of treating these lesions. The traditional anterolateral approach, the transpleural thoracotomy, is an extensive procedure that requires direct retraction of the lung, a deep surgical field, and postoperative closed-chest drainage. An alternative to this anterior approach, the retropleural thoracotomy, is described here. This approach provides the shortest direct route to the thoracic spine and leaves the pleura intact. A smaller incision and less retraction than traditional approaches may reduce postoperative pain and pulmonary-related complications. The retropleural thoracotomy is a valuable technique for the neurosurgeon treating thoracic disc disease.

Sign in / Sign up

Export Citation Format

Share Document