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.

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.

Spinal cord concussion

1990 ◽  
Vol 72 (6) ◽  
pp. 894-900 ◽  
Author(s):  
Thomas J. Zwimpfer ◽  
Mark Bernstein
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Content Type ◽  
Young Males ◽  
Cord Injury ◽  
Sensory Disturbances ◽  
Fine Print

✓ The hallmark of concussion injuries of the nervous system is the rapid and complete resolution of neurological deficits. Cerebral concussion has been well studied, both clinically and experimentally. In comparison, spinal cord concussion (SCC) is poorly understood. The clinical and radiological features of 19 SCC injuries in the general population are presented. Spinal cord injuries were classified as concussions if they met three criteria: 1) spinal trauma immediately preceded the onset of neurological deficits; 2) neurological deficits were consistent with spinal cord involvement at the level of injury; and 3) complete neurological recovery occurred within 72 hours after injury. Most cases involved young males, injured during athletics or due to falls. Concussion occurred at the two most unstable spinal regions, 16 involving the cervical spinal and three the thoracolumbar junction. Fifteen cases presented with combined sensorimotor deficits, while four exhibited only sensory disturbances. Many patients showed signs of recovery with the first few hours after injury and most had completely recovered within 24 hours. Only one case involved an unstable spinal injury. There was no evidence of ligamentous instability, spinal stenosis, or canal encroachment in the remaining 18 cases. Two patients, both children, suffered recurrent SCC injuries. No delayed deterioration or permanent cord injuries occurred. Spinal abnormalities that would predispose the spinal cord to a compressive injury were present in only one of the 19 cases. This suggests that, as opposed to direct cord compression, SCC may be the result of an indirect cord injury. Possible mechanisms are discussed.

Effect of delayed local cooling on experimental spinal cord injury

1975 ◽  
Vol 42 (2) ◽  
pp. 150-154 ◽  
Author(s):  
Phudhiphorn Thienprasit ◽  
Heinrich Bantli ◽  
James R. Bloedel ◽  
Shelley N. Chou
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neurological Deficits ◽  
Therapeutic Effects ◽  
Evoked Responses ◽  
Local Cooling ◽  
Content Type ◽  
Experimental Spinal Cord Injury ◽  
Cord Injury ◽  
Fine Print

✓ The authors report studies indicating that delayed local cooling is effective in minimizing the neurological deficits of experimental spinal cord injury in cats. Cortical evoked responses were useful in predicting the neurological outcome; untreated animals whose evoked response disappeared for 6 hours failed to recover whereas all treated animals in the same group recovered dramatically. Decompression by laminectomy alone proved ineffective. Possible explanations for the therapeutic effects of cooling and the significance of the delay are briefly discussed.

A novel surgical treatment of lumbar disc herniation in patients with long-standing degenerative disc disease

2005 ◽  
Vol 2 (5) ◽  
pp. 515-520 ◽  
Author(s):  
Markus Wenger ◽  
Thomas-Marc Markwalder
Keyword(s):  
Surgical Treatment ◽  
Lumbar Disc Herniation ◽  
Degenerative Disc Disease ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Total Disc Arthroplasty ◽  
Disc Disease ◽  
Disc Arthroplasty ◽  
Content Type ◽  
Fine Print

Object. In patients with long-standing lumbar degenerative disc disease (DDD) conventional surgical therapy of a herniated disc may worsen back pain due to further destabilization of the affected motion segment. In recent years, total-disc arthroplasty has been introduced to treat DDD while maintaining segmental mobility. To the best of the authors' knowledge, this is the first report involving lumbar disc herniation and long-standing DDD submitted to combined anterior microdiscectomy with sequestrectomy and total-disc arthroplasty. Methods. Fourteen patients with long-standing DDD and a recently herniated disc underwent total anterior lumbar microdiscectomy, with removal of the herniated disc, and total-disc arthroplasty. There were nine women and five men whose mean age was 39.6 years (range 22–56 years) in whom back and leg pain had been present for a mean of 75.4 (range 9–360) and 9.4 (range 0.33–36) months, respectively. Thirteen patients underwent L5—S1 and one underwent L4–5 surgery. In all cases the procedure and the postoperative courses were uneventful. After a mean follow-up period of 12.5 months (range 3.9–21.1 months), outcome was excellent in 11 and good in three patients. Conclusions. The aforementioned surgical treatment of a recently herniated lumbar disc in patients with long-standing DDD yielded very favorable early results.

Surgical technique and results of endoscopic anterior spinal canal decompression

2005 ◽  
Vol 2 (2) ◽  
pp. 128-136 ◽  
Author(s):  
Rudolf Beisse ◽  
Thomas Mückley ◽  
Meic H. Schmidt ◽  
Matthias Hauschild ◽  
Volker Büren
Keyword(s):  
Spinal Canal ◽  
Thoracolumbar Spine ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Disc Disease ◽  
Content Type ◽  
Neurological Improvement ◽  
Intercostal Neuralgia ◽  
Anterior Access ◽  
Fine Print

Object. Decompression of the spinal canal in the management of thoracolumbar trauma is controversial, but many authors have advocated decompression in patients with severe canal compromise and neurological deficits. Anterior decompression, corpectomy, and fusion have been shown to be more reliable for spinal canal reconstruction than posterior procedures; however, traditional anterior-access procedures, thoracotomy, and thoracoabdominal approaches are associated with significant complications. Endoscopy-guided spinal access avoids causing these morbidities, but it has not been shown to yield equivalent results in spinal canal clearance. This study was conducted to demonstrate the effectiveness of endoscopic spinal canal decompression and reconstruction quantitatively by using pre- and postoperative computerized tomography (CT) scanning. Methods. Thirty patients with thoracolumbar canal compromise underwent endoscopic anterior spinal canal decompression, interbody reconstruction, and stabilization for fractures (27 cases), and tumor, infection, and severe degenerative disc disease (one case each). The mean follow-up period was 42 months (range 24 months–6 years). Neurological examinations, Frankel grades, radiological studies, and intraoperative findings were prospectively collected. Spinal canal clearance quantified on pre- and postoperative CT scans improved from 55 to 110%. A total of 25% of patients with complete paraplegia and 65% of those with incomplete neurological deficit improved neurologically. The complication rate was 16.7% and included one reintubation, two pleural effusions, one intercostal neuralgia, and one persistent lesion of the sympathetic chain. Conclusions. The authors describe the endoscopic technique of anterior spinal canal decompression in the thoracolumbar spine. The morbidities associated with an open procedure were avoided, and excellent spinal canal clearance was accomplished as was associated neurological improvement.

Magnetic resonance imaging correlation in pediatric spinal cord injury without radiographic abnormality

2002 ◽  
Vol 97 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Amos O. Dare ◽  
Mark S. Dias ◽  
Veetai Li
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Content Type ◽  
Cord Injury ◽  
Frankel Grade ◽  
Fine Print

Object. The authors conducted a study to determine correlations between clinical syndromes and early magnetic resonance (MR) imaging—documented findings in children with spinal cord injury without radiographic abnormality (SCIWORA). Methods. The authors retrospectively reviewed the records obtained in 20 patients who presented with SCIWORA to the Children's Hospital of Buffalo between 1992 and 1999. Initial neurological syndromes, subsequent hospital course and outcome, and early MR imaging findings obtained using conventional sequences on a 1.5-tesla unit were recorded. Neurological syndromes on presentation were complete (Frankel Grade A) in two patients (10%), severe partial (Frankel Grade C) in one patient (5%), and mild partial (Frankel Grade D) in 17 patients (85%). Partial neurological deficits resolved in 14 (78%) of 18 patients within 72 hours and lasted more than 72 hours in four patients (22%). Magnetic resonance imaging was performed in both patients presenting with complete injuries and in 17 of 18 patients presenting with partial neurological deficits. The studies were obtained within 24 hours in 17 patients (85%). Neuroimaging revealed spinal cord swelling at the cervical level in one of the children with complete injury and cord edema with associated hemorrhage at cervical and thoracic levels in the other. Neural and extraneural elements were shown to be normal in all 17 patients with partial injuries who underwent MR imaging, including in the four patients with partial motor deficits lasting more than 72 hours. Conclusions. In this series, the predominant neurological presentation of SCIWORA was a mild, partial syndrome that resolved within 72 hours. Magnetic resonance imaging revealed abnormal features only in those patients with complete neurological deficits. These findings suggest that in the acute setting conventional MR imaging sequences may lack the sensitivity to demonstrate neural and extraneural abnormalities associated with partial or temporary neurological deficits of SCIWORA, even when those deficits persist beyond 72 hours.

A fatal, chronically growing basilar artery: a new type of dissecting aneurysm

1996 ◽  
Vol 84 (6) ◽  
pp. 962-971 ◽  
Author(s):  
Tohru Mizutani
Keyword(s):  
Mr Imaging ◽  
Basilar Artery ◽  
Dissecting Aneurysm ◽  
Neurological Deficits ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Asymptomatic Patients ◽  
Basilar Arteries ◽  
Fine Print

✓ A long-term follow-up study (minimum duration 2 years) was made of 13 patients with tortuous dilated basilar arteries. Of these, five patients had symptoms related to the presence of such arteries. Symptoms present at a very early stage included vertebrobasilar insufficiency in two patients, brainstem infarction in two patients, and left hemifacial spasm in one patient. Initial magnetic resonance (MR) imaging in serial slices of basilar arteries obtained from the five symptomatic patients showed an intimal flap or a subadventitial hematoma, both of which are characteristic of a dissecting aneurysm. In contrast, the basilar arteries in the eight asymptomatic patients did not show particular findings and they remained clinically and radiologically silent during the follow-up period. All of the lesions in the five symptomatic patients gradually grew to fantastic sizes, with progressive deterioration of the related clinical symptoms. Dilation of the basilar artery was consistent with hemorrhage into the “pseudolumen” within the laminated thrombus, which was confirmed by MR imaging studies. Of the five symptomatic patients studied, two died of fatal subarachnoid hemorrhage (SAH) and two of brainstem compression; the fifth patient remains alive without neurological deficits. In the three patients who underwent autopsy, a definite macroscopic double lumen was observed in both the proximal and distal ends of the aneurysms within the layer of the thickening intima. Microscopically, multiple mural dissections, fragmentation of internal elastic lamina (IEL), and degeneration of media were diffusely observed in the remarkably extended wall of the aneurysms. The substantial mechanism of pathogenesis and enlargement in the symptomatic, highly tortuous dilated artery might initially be macroscopic dissection within a thickening intima and subsequent repetitive hemorrhaging within a laminated thrombus in the pseudolumen combined with microscopic multiple mural dissections on the basis of a weakened IEL. The authors note and caution that symptomatic, tortuous dilated basilar arteries cannot be overlooked because they include a group of malignant arteries that may grow rapidly, resulting in a fatal course.

Progressive neurological deficits with benign intracerebral cysts

1986 ◽  
Vol 65 (5) ◽  
pp. 706-709 ◽  
Author(s):  
Yoko Nakasu ◽  
Jyoji Handa ◽  
Kazuyoshi Watanabe
Keyword(s):  
Histological Examination ◽  
Computerized Tomography ◽  
Cyst Wall ◽  
Benign Lesion ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Review Of The Literature ◽  
Content Type ◽  
Ct Findings ◽  
Fine Print

✓ Two patients with benign intracerebral cysts are reported and a brief review of the literature is given. Although computerized tomography (CT) scanning is useful in detecting a variety of intracerebral cysts, the CT findings are not specific for any lesion. An exploratory operation with establishment of an adequate route of drainage and a histological examination of the cyst wall are mandatory in the management of patients with a progressive but benign lesion.

Posterior epidural migration of sequestered lumbar disc fragments

1999 ◽  
Vol 90 (2) ◽  
pp. 264-266 ◽  
Author(s):  
Pierre Robe ◽  
Didier Martin ◽  
Jacques Lenelle ◽  
Achille Stevenaert
Keyword(s):  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Contrast Material ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Content Type ◽  
Diagnostic Pitfalls ◽  
Fine Print

✓ The posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. The authors report two such cases in which patients presented with either intense radicular pain or cauda equina syndrome. The radiological characteristics were the posterior epidural location and the ring enhancement of the mass after injection of contrast material. The major diagnostic pitfalls are discussed.

Split spinal cord malformations in children

1998 ◽  
Vol 88 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Yusuf Ersşahin ◽  
Saffet Mutluer ◽  
Sevgül Kocaman ◽  
Eren Demirtasş
Keyword(s):  
Spinal Cord ◽  
Neurological Deficits ◽  
Single Type ◽  
Type I ◽  
Type Ii ◽  
Content Type ◽  
Spinal Lesion ◽  
The Mean ◽  
Fine Print

Object. The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al. Methods. Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvement was observed in 18 patients. Conclusions. The classification of SSCMs proposed by Pang, et al., will eliminate the current chaos in terminology. In all SSCMs, either a rigid or a fibrous septum was found to transfix the spinal cord. There was at least one unrelated lesion that caused tethering of the spinal cord in 85% of the patients. The risk of neurological deficits resulting from SSCMs increases with the age of the patient; therefore, all patients should be surgically treated when diagnosed, especially before the development of orthopedic and neurological manifestations.

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