Circumferential Decompression via a ModifiedCostotransversectomy Approach for the Treatment of Single Level Hard Herniated Disc between T10–L1

Pei, Bo; Sun, Chao; Xue, Ruoyan; Xue, Yuan; Zhao, Ying; Zong, Yaqi; Lin, Wei; Wang, Pei

doi:10.1111/os.12223

Cited by 8 publications

(13 citation statements)

References 45 publications

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“…Задний хирургический доступ не является универсальным для удаления грыж всех видов и локализаций, поскольку сопряжен с риском серьезных неврологических осложнений. Применение задних доступов в значительной мере ограничено случаями мягкотканных латеральных и парамедианных грыж, однако некоторые модификации задних доступов, в частности удаление грыжи по типу яичной скорлупы, позволяют в ряде случаев успешно удалять и оссифицированные грыжи грудных дисков [13].…”

Section: Discussionunclassified

Removal of the intervertebral thoracic disc hernia under intraoperative neuromonitoring: case series

et al. 2019

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Objective. To analyze the results of the removal of thoracic intervertebral disc hernia through posterior surgical approach using intraoperative neuromonitoring.Material and Methods. A total of 14 patients aged 43–64 years (M = 53.9) were operated on through posterior approach for symptomatic hernia of the thoracic intervertebral discs, with myelopathy (isolated or in combination with radiculopathy) in seven cases, and with isolated radiculopathy in another seven cases. Hernia were ossified in 6 cases. Operations were performed using intraoperative neuromonitoring. In 11 cases, unilateral or bilateral laminectomy and facetectomy were performed to remove a hernia; in three cases – laminectomy with resection of the facet joints and pedicles (in two of them, with ossified large and giant hernias, radiculotomy was performed to mobilize the dural sac).Results. The long-term clinical results of surgical interventions were evaluated 1–4 years after the surgery using VAS-10, ODI, and Frankel scales. VAS scores decreased by 2–6 points In 11 patients, and remained at the same low level characterized by mild pain (1–2 points) in three patients. In patients with myelopathy, the Frankel scale showed a positive trend in six out of seven cases. Two patients showed an increase in neurological deficit in the postoperative period. In one case, neurological disorders regressed within a short period of time, in the other one, they became permanent. Damage to the dura mater was observed in two cases.Conclusion. Intraoperative neuromonitoring allows the surgeon to act more actively and confidently in the area of disco-medullar conflict and thereby avoid excessive expansion of surgical approach without compromising the surgical result. A small number of observations does not allow making evidence-based conclusion.

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Section: Discussionunclassified

Removal of the intervertebral thoracic disc hernia under intraoperative neuromonitoring: case series

et al. 2019

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“…A fentiek miatt többfajta, módosított costotransversectomiás eljárást is kidolgoztak, amelyekkel akár 86%-ra emelték a feltárás és a mûtét eredményességét, viszont ezek a szövôdményrátát növelve a feltárás fokozott invazivitását és kiterjesztését von ták maguk után, továbbá az esetek jelentôs részé ben (18%) a gerinc statikáját rontva gerincstabilizálást is szükségessé tettek 16 .…”

Section: áBra a T2-súlyozott Saggitalis (A) éS Axiális Síkú Thoracalis Mr-felvételeken Láthatók Az Eltávolított Th Viii-as (B) éS Th Ix-eunclassified

A thoracalis porckorong-sérvesedés hátsó transduralis feltárása során nyert korai tapasztalatok a Szegedi Tudományegyetem, Idegsebészeti Klinikán

Márkos-Gergely¹,

Watfa²,

Balázsfi³

et al. 2020

Ideggyogy Sz

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Background -Because of the rare occurrence of thoracic disc herniation and surgery needed treatment the used approaches and their efficiency are still subjects of discussions. In Hungarian practice, the most frequent explorations are costotransversectomy and laminectomy, but there are many other important methods available like thoracoscopic and posterior transdural approaches. This case report will present the benefits and the surgical procedure of posterior transdural sequesterectomy, carry out for the first time in Hungary at the Neurosurgical Department on Szeged University. Case presentation -A 50-year-old female patient with achondroplasic nanism has been operated several times since 2011. She suffered from a progressive, multi-segment affected degenerative discopathy and myelopathy. Finally in the background of the recurrent paraparesis was confirmed thoracic disc herniations at the levels of T8 and T9. The use of intraoperative electrophysiology was not feasable, because the earlier described cervical myelopathy. For this reason we used the posterior transdural approach, as the best and safest, visual control warranted technique. Conclusions -The posterior transdural approach offers an alternative option for experienced surgeons, furthermore in contrast with traditional, technically difficult to implement or special instrumentation demanding approaches this technique seems to be more efficient.

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“…Выбор оптимальной методики оперативного лечения представляет собой непростую задачу для хирурга. Требования к хирургическому доступу определены и четко сформулированы: доступ должен обеспечить удаление грыжи и, что чрезвычайно важно, минимизировать контакт со спинным мозгом [6][7][8][9]. Целью оперативных вмешательств в иссле-дованиях являлась декомпрессия спинного мозга, а при изолированной радикулопатии -скомпрометированного спинно-мозгового корешка.…”

Section: результаты и их обсуждениеunclassified

“…Авторы публикаций, посвященных заднему доступу, видят его преиму-щество не только в меньшей частоте осложнений, но и в лучшей возможности контролировать эпидуральное пространство, его венозные сосуды и состояние твердой мозговой оболочки [7,19,22]. Разнообразие задних доступов расширяет возможности их применения и позволяет удалять не только мягкотканные латерально расположенные, но и медиальные оссифицированные грыжи диска [7,8,20,21,22,25]. Coppes et al [21], удалив 13 грыж из заднего трансдурального доступа, получили благоприятные результаты во всех наблюдениях.…”

Section: отбор публикаций для обзораunclassified

Surgery of Thoracic Disc Herniation: A Systematic Review of English-Language Literature

Simonovich

2019

Hir. pozvonoč.

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The presented review of scientific publications from the Medline (PubMed) and Scopus databases considers modern surgical approaches used to remove intervertebral hernias in the thoracic spine. The advantages and disadvantages of anterior and posterior approaches are analyzed. It has been revealed that the anterior approaches, providing a good opportunity to remove a hernia, are associated with the risk of serious complications, including pulmonary ones, and often lead to the formation of a post-thoracotomy pain syndrome. Mini-thoracotomy and percutaneous thoracoscopy, although less invasive, do not exclude the development of complications inherent in conventional thoracotomy. Modern posterior approaches are less traumatic and allow, with minimal contact with the spinal cord, to successfully remove not only soft tissue, but also ossified disc herniation. The choice of the optimal method of discectomy remains an unsolved problem and depends on practical skills, experience and preferences of the surgeon. For an objective and reliable assessment of the efficiency of surgical technologies and the determination of optimal indications for each of them, a prospective multicenter study is necessary.

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Circumferential Decompression via a ModifiedCostotransversectomy Approach for the Treatment of Single Level Hard Herniated Disc between T₁₀–L₁

Cited by 8 publications

References 45 publications

Removal of the intervertebral thoracic disc hernia under intraoperative neuromonitoring: case series

Removal of the intervertebral thoracic disc hernia under intraoperative neuromonitoring: case series

A thoracalis porckorong-sérvesedés hátsó transduralis feltárása során nyert korai tapasztalatok a Szegedi Tudományegyetem, Idegsebészeti Klinikán

Surgery of Thoracic Disc Herniation: A Systematic Review of English-Language Literature

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