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.

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

1995 ◽  
Vol 83 (6) ◽  
pp. 971-976 ◽  
Author(s):  
Charles B. Stillerman ◽  
Thomas C. Chen ◽  
J. Diaz Day ◽  
William T. Couldwell ◽  
Martin H. Weiss
Keyword(s):  
Spinal Column ◽  
Radicular Pain ◽  
Minimal Amount ◽  
Content Type ◽  
Soft Tissue Dissection ◽  
Disc Herniations ◽  
Axial Pain ◽  
Thoracic Disc ◽  
Ventral Canal ◽  
Fine Print

✓ 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 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.

Thoracoscopic microsurgical excision of herniated thoracic discs

1998 ◽  
Vol 89 (2) ◽  
pp. 224-235 ◽  
Author(s):  
Daniel Rosenthal ◽  
Curtis A. Dickman
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Radicular Pain ◽  
Content Type ◽  
Neurological Outcomes ◽  
Intercostal Neuralgia ◽  
The Mean ◽  
Postoperative Atelectasis ◽  
Fine Print

Object. The authors began using thoracoscopy to treat pathological conditions of the spine in 1992. In this study they delineate their clinical experience in which this procedure was used to resect herniated thoracic discs. Methods. Fifty-five patients underwent thoracoscopy for the resection of herniated thoracic discs. Thirty-six patients presented with myelopathies and 19 with incapacitating thoracic radicular pain. Forty-three patients underwent a single-level, 11 a two-level, and one a three-level discectomy. The mean operative time for thoracoscopic microdiscectomy was 3 hours and 25 minutes (range 80–542 minutes) and the mean blood loss was 327 ml (range 124–1500 ml). Compared with thoracotomy, which was performed in 18 patients, thoracoscopy was associated with a mean of 1 hour less operative time and less than one-half of the blood loss, duration of chest tube drainage, usage of pain medication, and length of hospitalization. Compared with costotransversectomy, which was performed in 15 patients, thoracoscopy permitted more complete resection of calcified and midline thoracic discs because it provided a direct view of the entire anterior surface of the dura. Thoracotomy was associated with a significantly greater incidence of prolonged, disabling intercostal neuralgia compared with the mild transient episodes of intercostal neuralgia associated with thoracoscopy (50% compared with 16%). Thoracotomy also was associated with a significantly higher incidence of postoperative atelectasis and pulmonary dysfunction than thoracoscopy (33% compared with 7%). Clinical and neurological outcomes were excellent (mean follow-up period 15 months). Among the 36 myelopathic patients, 22 completely recovered neurologically; five improved functionally but had some residual myelopathic symptoms; and nine stabilized. Among the 19 patients with isolated thoracic radiculopathies, 15 recovered completely and four improved moderately; no patient had worsened radicular pain. Conclusions. Thoracoscopic microdiscectomy is a reliable surgical technique that can be performed safely with excellent clinical and neurological results.

Thoracic microendoscopic discectomy

2004 ◽  
Vol 1 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Mick J. Perez-Cruet ◽  
Bong-Soo Kim ◽  
Faheem Sandhu ◽  
Dino Samartzis ◽  
Richard G. Fessler
Keyword(s):  
Minimally Invasive ◽  
Disc Herniation ◽  
Thoracic Disc Herniation ◽  
Tubular Retractor ◽  
Content Type ◽  
Estimated Blood Loss ◽  
Disc Herniations ◽  
Microendoscopic Discectomy ◽  
Thoracic Disc ◽  
Fine Print

Object. Various approaches exist for the treatment of thoracic disc herniation. Anterior approaches facilitate ventral exposure but place the intrathoracic contents at risk. Posterolateral approaches require extensive muscle dissection that adds to the risk of postoperative morbidity. The authors have developed a novel posterolateral, minimally invasive thoracic microendoscopic discectomy (TMED) technique that provides an approach to the thoracic spine which is associated with less morbidity. Methods. Seven patients 23 to 54 years old with nine disc herniations underwent TMED. All lesions were soft lateral or midline thoracic disc herniations. Under fluoroscopic guidance with the patient positioned prone, the authors used a muscle dilation approach and the procedure was performed with endoscopic visualization through a tubular retractor. Based on a modified Prolo Scale, five patients experienced excellent results, one good, and one fair. No case required conversion to an open procedure. The mean operative time was 1.7 hours per level, and estimated blood loss was 111 ml per level. Hospital stays were short, and no complications occurred. Conclusions. The TMED is safe, effective, and provides a minimally invasive posterolateral alternative for treatment of thoracic disc herniation without the morbidity associated with traditional approaches.

Extreme-lateral lumbar disc herniations

1974 ◽  
Vol 41 (2) ◽  
pp. 229-234 ◽  
Author(s):  
A. F. Abdullah ◽  
Edward W. Ditto ◽  
Edward B. Byrd ◽  
Ralph Williams
Keyword(s):  
Back Pain ◽  
Clinical Picture ◽  
Lumbar Disc ◽  
Clinical Syndrome ◽  
Leg Pain ◽  
Sensory Loss ◽  
Lateral Bending ◽  
Content Type ◽  
Disc Herniations ◽  
Fine Print

✓ The authors believe that posterior lumbar disc herniations that occur far laterally (beneath, or beyond the facet) present a clinical picture and special problems of diagnosis different from those encountered with the usual herniations within the spinal canal. In a series of 204 consecutive disc operations, there were 24 “extreme-lateral” disc herniations at the second, third, or fourth lumbar interspace, none at the lumbosacral joint. When compared with the incidence of posterior herniations above the fourth interspace, it appeared that “extreme-lateral” herniations were responsible for the majority of second, third and fourth lumbar root compressions. The clinical syndrome is characterized by anterior thigh and leg pain, absent knee jerk, and sensory loss in the appropriate dermatome but also by the absence of back pain, typical back signs, or positive Lasegue's sign. Reproduction of pain and paresthesia by lateral bending to the side of the lesion is a reliable diagnostic sign. The authors report that myelography fails to disclose these lesions, while discography often proves helpful.

Multiple thoracic disc herniations

1987 ◽  
Vol 66 (2) ◽  
pp. 290-292 ◽  
Author(s):  
Lawrence S. Chin ◽  
Keith L. Black ◽  
Julian T. Hoff
Keyword(s):  
Surgical Approach ◽  
Preoperative Diagnosis ◽  
Previous Literature ◽  
Content Type ◽  
Disc Herniations ◽  
Thoracic Disc ◽  
Fine Print

✓ A patient with herniated thoracic discs in tandem is reported. The previous literature is reviewed. Difficulties with the preoperative diagnosis and the surgical approach to these lesions are discussed.

A new denervation procedure for idiopathic cervical dystonia

2002 ◽  
Vol 97 (2) ◽  
pp. 201-206 ◽  
Author(s):  
Takaomi Taira ◽  
Tomonori Kobayashi ◽  
Kenji Takahashi ◽  
Tomokatsu Hori
Keyword(s):  
Blood Loss ◽  
Cervical Dystonia ◽  
Symptomatic Improvement ◽  
Sensory Loss ◽  
Intraoperative Blood Loss ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The Bertrand selective peripheral denervation for cervical dystonia (CD) has been well described, and its effectiveness and safety are established. It is, however, always accompanied by postoperative sensory loss in the C-2 region. Intraoperative bleeding from epidural venous plexuses may also be problematic. The authors developed a new denervation procedure with which to avoid such complications and compared the surgery-related results with those of the traditional Bertrand operation. Methods. The new procedure consists of intradural rhizotomy of the anterior C-1 and C-2 nerve roots, extradural peripheral ramisectomy from C-3 to C-6, and selective section of peripheral branches of the accessory nerve to the sternocleidomastoid muscle. This procedure was performed in 30 patients (Group A). The results of this procedure were compared with those obtained in a matched group of 31 patients in the authors' series who underwent Bertrand denervation (Group B). Changes of CD rating score at 6-month follow up did not differ between the two groups. In one patient in Group A a C-2 sensory deficit was found, whereas C-2 sensory deficits were demonstrated in all the patients in Group B. No patients in Group A and four patients in Group B experienced occipital neuralgia. The operative time was significantly shorter in Group A. The mean intraoperative blood loss was 115 ± 30 ml (± standard deviation) in Group A and 233 ± 65 ml in Group B (p < 0.005). Conclusions. Although symptomatic improvement is the same after the Bertrand operation, the authors' new procedure for CD was associated with a lower incidence of complications and significant decrease of intraoperative blood loss.

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.

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.

Cervicothoracic radiculopathy treated using posterior cervical foraminotomy/discectomy

2003 ◽  
Vol 98 (2) ◽  
pp. 131-136 ◽  
Author(s):  
James S. Harrop ◽  
Marco T. Silva ◽  
Ashwini D. Sharan ◽  
Steven J. Dante ◽  
Frederick A. Simeone
Keyword(s):  
Morbidity Rate ◽  
Symptom Duration ◽  
Specific Information ◽  
Disc Disease ◽  
Content Type ◽  
Included Patient ◽  
Posterior Cervical Foraminotomy ◽  
Disc Herniations ◽  
Fine Print

Object. The authors conducted a study to identify the effectiveness and morbidity rate associated with treating cervicothoracic disc disease (radiculopathy) via a posterior approach. Methods. Nineteen patients underwent posterior cervicothoracic laminoforaminotomy during a 5.6-year period. Medical records, imaging studies, office charts, hospital records, and phone interview data were reviewed. Specific information analyzed included patient demographics, side of lesion, and conservative treatment, symptoms, and pre- and postoperative pain levels. Pain was rated using a visual analog scale and classified into a radicular and neck component. Data in 19 patients (seven women and 12 men) who underwent 20 procedures (one patient underwent separate bilateral foraminotomies) were analyzed. The mean patient age was 54.8 years (range 38–73 years), and the follow-up period ranged from 23 to 62 months. Symptom duration ranged from 1 to 14 months (mean 3.4 months) and consisted of weakness, numbness, and painful radiculopathies in 11, 16, and 20 cases, respectively. Motor weakness was identified in 11 of 19 patients (mean grade of 4.35), and postoperatively strength normalized in eight of 11 (mean grade of 4.79). The improvement in motor scores was significant (p = 0.007). Pain was the most common presenting symptom. Preoperative radiculopathies were rated between 0 and 10 (mean 7.45), and postoperatively scores were reduced to 0 to 3 (mean 0.2) which was significant (p < 0.0001). Preoperative neck pain was rated between 0 and 8 (mean 2.55), and on follow up ranged from 0 to 2 (mean 0.5), which was also significant (p = 0.001). Conclusions. Posterior cervicothoracic foraminotomy was a safe and effective procedure in the treatment of patients with laterally located disc herniations.

Sign in / Sign up

Export Citation Format

Share Document