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.

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.

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 Anterolateral Approach for Thoracic Disc Disease

1988 ◽  
Vol 28 (8) ◽  
pp. 798-801 ◽  
Author(s):  
Yoshinobu IWASAKI ◽  
Hiroshi ABE ◽  
Mitsuhiro TADA ◽  
Toyohiko ISU ◽  
Minoru AKINO ◽  
...  
Keyword(s):  
Anterolateral Approach ◽  
Disc Disease ◽  
Thoracic Disc

scholarly journals Surgical treatment of thoracic disc herniation using the anterior approach

1982 ◽  
Vol 64-B (3) ◽  
pp. 340-343 ◽  
Author(s):  
K Otani ◽  
S Nakai ◽  
Y Fujimura ◽  
S Manzoku ◽  
K Shibasaki
Keyword(s):  
Surgical Treatment ◽  
Disc Herniation ◽  
Anterior Approach ◽  
Thoracic Disc Herniation ◽  
Thoracic Disc

Thoracic disc disease

2010 ◽  
pp. 821-823
Author(s):  
George Samandouras
Keyword(s):  
Surgical Technique ◽  
Clinical Presentation ◽  
Surgical Anatomy ◽  
Open Thoracotomy ◽  
Disc Disease ◽  
Endoscopic Discectomy ◽  
Thoracic Disc

Chapter 16.9 covers thoracic disc disease, including epidemiology, clinical presentation, imaging, management, surgical anatomy, surgical technique of costotransversectomy, surgical technique of open thoracotomy, and surgical technique of endoscopic discectomy.

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 Extended Transcaruncular Approach Using Detachment and Repositioning of the Inferior Oblique Muscle for the Traumatic Repair of the Medial Orbital Wall

2009 ◽  
Vol 2 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Javier Rodriguez ◽  
Ramon Galan ◽  
Gabriel Forteza ◽  
Mario Mateos ◽  
Jens Mommsen ◽  
...  
Keyword(s):  
Oblique Muscle ◽  
Facial Trauma ◽  
Inferior Oblique Muscle ◽  
Orbital Trauma ◽  
Standard Material ◽  
Orbital Wall ◽  
Surgical Field ◽  
Medial Orbital Wall ◽  
Traditional Approaches ◽  
Upper Third

The fracture of the medial orbital wall is relatively common in orbital trauma. Titanium mesh is possibly the actual standard material for orbital wall reconstruction. When the floor of the orbit and the medial wall are simultaneously affected, one larger mesh gives better results than two independent meshes that need to be fixated independently. However, large meshes need a wider surgical field. To gain sufficient exposure to the medial and inferior orbital walls simultaneously, we present an approach that combines the transconjunctival and transcaruncular incisions, detaching if needed the inferior oblique muscle and, placing our mesh, repositioning it beside the lacrimal duct. This technique should not entirely displace traditional approaches, but it widens the surgical exposure for middle- and upper-third facial trauma. This alternative has minimum morbidity and can save a great deal of surgery time.

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