Anterior Transthoracic Surgery with Motor Evoked Potential Monitoring for High-Risk Thoracic Disc Herniations: Technique and Results

Cornips, Erwin M. J.; Habets, Jeroen; Kranen-Mastenbroek, Vivianne van; Bos, Herman; Bergs, Paul; Postma, Alida A.

doi:10.1016/j.wneu.2017.05.173

Cited by 16 publications

(11 citation statements)

References 52 publications

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“…Apparently, good or satisfactory clinical results gave the surgeons a false sense of success. This phenomenon is not exclusive to posterior approaches, but has been reported with anterior approaches as well [10]. Thorough analysis of the approach technique and possible alternatives in case of intraoperative unforeseen complications must play an important role when reoperating thoracic discs.…”

Section: Discussionmentioning

confidence: 95%

“…The development of new instruments and refined surgical techniques has brought up alternative techniques to replace classic thoracotomy. Thoracoscopy [10,21] or retropleural mini-open techniques (mini-TTA) [12,[22][23][24][25] have been reported with better results concerning post-operative pulmonary and shoulder dysfunction as well as post-thoracotomy pain syndrome [26][27][28][29]. Because of it, less demanding learning curve mini-TTA may be prioritized; however, in experienced and well-trained hands, thoracoscopy is the optimal technique when seeking for a less aggressive and equally effective alternative available nowadays [30].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, residual compression or neurological worsening [11,23] is not a phenomenon that occurs only in posterior approaches. Revision because of residual disc material has been reported in various series reviewing anterolateral approaches as well [10,13,33]. These cases were operated in the early stage of the technique.…”

Section: Discussionmentioning

confidence: 99%

“…These cases were operated in the early stage of the technique. The availability of intraoperative CT imaging might prevent revision cases in future [10].…”

Section: Discussionmentioning

confidence: 99%

“…Adequate invasive techniques and instruments have been developed for thoracic and lumbar approaches popularizing the principle of approaching the thoracic spine anterolaterally. However, few articles have been published in the literature dealing with strategies for the reoperation of residual or recurrent thoracic disc herniations [10][11][12][13].…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

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Revision surgery in thoracic disc herniation

2019

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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 abstractThese slides can be retrieved under Electronic Supplementary Material. Key points3. These lesions require a ventral operative approach to obtain adequate visualization of the dura to resect the discs completely.Dützmann S, Rose R, Rosenthal D (2019) Revision surgery in thoracic disc herniation. Eur Spine J; Keywords Thoracic disc disease · Revision surgery · Thoracoscopy · EndoscopyPublisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Affiliations

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…These cases were operated in the early stage of the technique. The availability of intraoperative CT imaging might prevent revision cases in future [10].…”

Section: Discussionmentioning

confidence: 99%

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

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Revision surgery in thoracic disc herniation

2019

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Thoracoscopic Microdiscectomy with Preservation of Rib and Costovertebral Joint

Cornips

Beuls²

2022

Advances and Technical Standards in Neurosurgery

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Surgical treatment of thoracic disc herniation: an overview

Bouthors

Benzakour

Court

2018

International Orthopaedics (SICOT)

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Background Surgical treatment of thoracic disc herniation (TDH) is technically demanding due to its proximity to the spinal cord. Methods Literature review. Results Symptomatic TDH is a rare condition predominantly localized between T8 and L1. Surgical indications include intractable back or radicular pain, neurological deficits, and myelopathy signs. Giant calcified TDH (> 40% spinal canal occupation) are frequently associated with myelopathy, intradural extension, and post-operative complications. Careful pre-operative planning helps reduce the risk of complications. Pre-operative CT and MRI identify the hernia's location and size, calcifications, and intradural extension. The approach must provide adequate dural sac visualization with minimal manipulation of the cord. Nonanterior approaches are favoured if they provide at least equal exposure than anterior approach owing to higher risk of pulmonary morbidity associated with anterior approach. A transthoracic approach is recommended for central calcified herniated discs. A posterolateral approach is often suitable for non-calcified lateralized TDH. Thoracoscopic approaches are less invasive but have a substantial learning curve. Retropleural mini-thoracotomy is an acceptable alternative. Pre-operative identification of the pathological level is confirmed by intra-operative level check. Intra-operative cord monitoring is preferable but warrant further studies. Magnification and adequate lightening of the surgical field are paramount (microscope, thoracoscopy). Intra-operative CT scan with navigation is becoming increasingly popular since it provides real-time control on the decompression. Indications of fusion consist of pre-operative back pain, Scheuermann's disease, multilevel resection, wide vertebral body resection (> 50%), and herniation at thoracolumbar junction. Neurological deterioration, dural tear, and subarachnoid-pleural fistula are the most severe complications. Conclusion Further improvements are still warranted in thoracic spine surgery despite the advent of minimally invasive techniques. Intra-operative CT scan will probably enhance the safety of the TDH surgery.

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Anterior Transthoracic Surgery with Motor Evoked Potential Monitoring for High-Risk Thoracic Disc Herniations: Technique and Results

Cited by 16 publications

References 52 publications

Revision surgery in thoracic disc herniation

Revision surgery in thoracic disc herniation

Thoracoscopic Microdiscectomy with Preservation of Rib and Costovertebral Joint

Surgical treatment of thoracic disc herniation: an overview

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