Anterior versus posterior approaches for thoracic disc herniation: Association with postoperative complications

Kerezoudis, Panagiotis; Rajjoub, Kenan; Goncalves, Sandy; Alvi, Mohammed Ali; Elminawy, Mohamed; Alamoudi, Abdullah; Nassr, Ahmad; Habermann, Elizabeth B.; Bydon, Mohamad

doi:10.1016/j.clineuro.2018.02.009

Cited by 26 publications

(30 citation statements)

References 22 publications

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“…6,7 Thus, trans-thoracic approach became a gold standard approach in the management of severe canal compromised TDP. 8,9 In a systematic review of 164 patients analyzed, 3%, 13%, and 25% had permanent neurologic deterioration in surgery via the transthoracic approach, the posterolateral approach, and the thoracoscopy approach, respectively. 9 However, posterior approach decompression with or without fusion has been advocated as an alternative and successful treatment modality in other reports.…”

Section: Introductionmentioning

confidence: 99%

“… 8 , 9 In a systematic review of 164 patients analyzed, 3%, 13%, and 25% had permanent neurologic deterioration in surgery via the transthoracic approach, the posterolateral approach, and the thoracoscopy approach, respectively. 9 However, posterior approach decompression with or without fusion has been advocated as an alternative and successful treatment modality in other reports. 10 – 17 One of the main problems is that an accomplished spine surgeon will see very low numbers of TDP in his life time.…”

Section: Introductionmentioning

confidence: 99%

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Transforaminal Thoracic Interbody Fusion for Thoracic Disc Prolapse: Surgicoradiological Analysis of 18 Cases

Krishnan

Degulmadi

Mayi

et al. 2019

Global Spine Journal

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Study Design: Retrospective observational study. Objectives: Thoracic disc prolapse (TDP) surgeries have reported complications ranging from paraplegia to approach related complications. This study is to present a series of TDP patients surgically treated with transforaminal thoracic interbody fusion (TTIF). Emphasis on surgical technique and strategies to avoid complications are analyzed. Methods: Eighteen patients with TDP were included. Imagings were analyzed for end-plate changes and calcification. Type of disc prolapse (central/para-central) and percentage of canal occupancy were noted. Objective outcome was quantified with Visual Analogue Scale (VAS), modified Nurick’s grade, and ASIA (American Spinal Injury Association) score. All complications were noted. Results: Eighteen patients (average age 43.65 years) having total 22 levels operated, that included double level (n = 2) and missed level (n = 2) are reported. All patients had myelopathy. Calcification of disc (n = 13), central disc prolapses (n = 9), para-central (n = 11) and more than 50% canal occupancy (n = 8) were noted. VAS back pain, modified Nurick’s grade and ASIA grade improved significantly in all patients. One patient had postoperative transient deficit. The functional score achieved its maximum at 1 year follow-up and remained static at final follow-up of 65.05 months. Union was achieved in all patients. Conclusions: The most important factor for outcome in TDP is the technical aspect of avoiding cord manhandling and avoiding wrong level surgeries. TTIF is not devoid of complications but can give good results to posterior approach trained surgeons.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transforaminal Thoracic Interbody Fusion for Thoracic Disc Prolapse: Surgicoradiological Analysis of 18 Cases

Krishnan

Degulmadi

Mayi

et al. 2019

Global Spine Journal

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“…There are now five types of surgical access for the treatment of TDH, including anterior access, lateral access, pedicle access, intervertebral access, thoracoscopic Access. According to the literature, anterior surgical access is more difficult to learn and has a higher incidence of complications [1]. When encountering large disc size, disc calcification and central TDH, the intervertebral approach is not applicable, and there is a lack of treatment in the current literature Evidence for the safety of surgical access for TDH is attributed to, among other reasons, the low incidence of TDH.…”

Section: Discussionmentioning

confidence: 99%

“…Major Cause. Thoracic disc herniation (TDH) has a low prevalence, literature Reported to account for approximately 0.25-0.75% of spinal disc herniations, compared to an incidence of 0.1% in the general population-0.0001% [1]. It mainly occurs between T8-L1, most often between 30-50 years old, with an equal proportion of men and women, with complex and varied clinical manifestations, diagnostic difficulties and surgical difficulties [2].…”

Section: Introductionmentioning

confidence: 99%

Anatomic morphological study of thoracolumbar foramen in normal adults

Wang

Cai

et al. 2021

Folia Morphol

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Background: Based on CT images of the thoracolumbar intervertebral foramen and its surrounding parameters, and analyzing the intervertebral foramen morphology and the correlation between the measured parameters, to provide an anatomical basis for clinical minimally invasive transvertebral surgery. Materials and methods: Ten fresh adult cadaveric specimens (32-50 years old) with bilateral (T1-S1) spinal segments were selected for a total of 20 sides, a total of 340 intervertebral foramen, were measured with vernier calipers in the Department of Anatomy, Inner Mongolia Medical University. The intervertebral foramen height, the minimum sagittal diameter of the foramen, the width of the spinal ganglion, the sagittal diameter of the spinal ganglion and the sagittal diameter of the intervertebral foramen were measured. This study was reviewed and approved by the local Ethics Committee. Results: The results of the minimum sagittal diameter of the T9-10~L5/S1 intervertebral foramen were 6.

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“…Intra-operative neurological monitoring and intra-operative optical magnification are usually used to enhance the safety of TDH surgery and decrease the surgical complications and mortality rates (2,11). In spite of these strategies being implemented, surgical complications can still occur to some extent, such as vertebral column instability, neurologic injury, and thoracic complications (1,12,13). The bone structure and nerves should be anatomically clear to reduce the occurrence of surgical complications.…”

Section: Introductionmentioning

confidence: 99%

The projection of the thoracic nerve roots and their connection with intervertebral discs: a cadaver and radiological study

et al. 2019

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Background The anatomical features of the thoracic nerve roots in connection with intervertebral discs may prevent surgery-related complications and improve patients’ neurological functional status during thoracic spine surgery. There is limited literature evidence regarding this concept using cadavers. Purpose To elucidate the qualitative anatomical features of the thoracic nerve roots in connection with intervertebral discs. Material and Methods Fifteen formalin-preserved spine specimens were used in this study. Small pieces of stainless-steel wires were placed along the root sleeves from their points of origin, after exposing the dural sac and bilateral nerve roots. The standard anteroposterior and lateral radiographs were taken after the placement of the wires. Measurements were done on radiographs using the picture archiving communication system. Results Take-off angles of the nerve roots at the coronal plane gradually increased from the level of T2 (36.1°±2.72°) to T9 (84.1°±1.84°) and from T9, it decreased to T12 (46.3° ± 2.67°). Similar variation tendency was discovered in take-off angles of the nerve roots at the sagittal plane. No consistent tendency was found both in the distance from the origin of the root sleeve to its superior and inferior vertebral endplate. Distance from the origin of the root sleeve to the posterior midline (DM) exponentially decreased from T1 (8.2 ± 0.87 mm) to T4 (6.0 ± 0.93 mm). It slowly increased from T5 (5.5 ± 0.68 mm) to T12 (10.9 ± 1.79 mm), with T5 having the smallest DM. Distance between the origins of neighboring nerve roots showed an obvious increase from the T1–T2 interval (23.1 ± 2.22 mm) to T7–T8 interval (30.9 ± 2.68 mm). However, it progressively decreased at the T10–T11 interval (26.0 ± 2.40 mm). Conclusion The dimensions of the thoracic nerve roots vary greatly from T1 to T12 intervertebral discs. Sound knowledge of these anatomical features of the thoracic nerve is mandatory for the thoracic spine surgery, especially in the posterolateral approach and transforaminal endoscopic surgery.

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Anterior versus posterior approaches for thoracic disc herniation: Association with postoperative complications

Cited by 26 publications

References 22 publications

Transforaminal Thoracic Interbody Fusion for Thoracic Disc Prolapse: Surgicoradiological Analysis of 18 Cases

Transforaminal Thoracic Interbody Fusion for Thoracic Disc Prolapse: Surgicoradiological Analysis of 18 Cases

Anatomic morphological study of thoracolumbar foramen in normal adults

The projection of the thoracic nerve roots and their connection with intervertebral discs: a cadaver and radiological study

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