Giant central thoracic disc herniations: surgical outcome in 17 consecutive patients treated by mini-thoracotomy

Abstract

Patients with myelopathy due to giant cTDH can be safely treated by the mini-thoracotomy approach. Postoperative neurological worsening and severe complications or incisional pain are rare. In contrast to complex posterior or thoracoscopic approaches, the mini-thoracotomy is technically straightforward and thus easy to learn for experienced spine surgeons.

Decompression of the anterior thoracic spinal canal using a novel full‐endoscopic uniportal transthoracic retropleural technique—an anatomical feasibility study in human cadavers

“…Myelopathies are caused primarily by compression of the anterolateral funiculus and can produce signs of central neurological deficits (hyperreflexia, gait disorders, paresis, bladder disorders, paraplegia, etc.) (Quint et al, ; Roelz et al, ). Atypical symptoms (e.g., gastrointestinal, cardiopulmonary, abdominal) have also been reported (Rohde and Kang, ; Shirzadi et al, ).…”

“…A special form termed giant disc herniation (Hott et al, 2005) displaces >40% of the spinal canal, is often calcified, erodes the dura mater, and causes myelopathy. The pathophysiology of its development is unclear (Cornips et al, 2011;McInerney and Ball, 2000;Roelz et al, 2016).…”

“…Anterior approaches allow sufficient and direct access to the anterior spinal canal, but opening the thoracic and pleural cavity can lead to problems (e.g., pulmonary dysfunction, thorax pain, increased morbidity) (Roelz et al, 2016;Yoshihara and Yoneoka, 2014) and can be made more difficult by certain anatomical or pathological conditions (previous operations, bronchopulmonary diseases, upper thoracic spine, etc.) (Roelz et al, 2016;Yoshihara and Yoneoka, 2014). Anterior approaches also have negative aspects, probably approach-related, for example, higher overall complication rates in the hospital, a higher mortality rate, longer hospital stays, and higher hospital costs (Fessler and Sturgill, 1998;Yoshihara and Yoneoka, 2014).…”

“…Thoracic disc herniations are rare and constitute only 0.15% to 4% of all nucleotomies of the spine. They can be soft or calcified (Roelz et al, 2016;Stillerman et al, 1998). A special form termed giant disc herniation (Hott et al, 2005) displaces >40% of the spinal canal (McInerney and Ball, 2000;Roelz et al, 2016).…”

“…The nonanterior approaches can involve difficult or inadequate visualization or handling of the area anterior to the spinal cord and approach-related destabilization of the posterior structures (Bilsky, 2000;Borm et al, 2011). Anterior approaches allow sufficient and direct access to the anterior spinal canal, but opening of the thoracic and pleural cavity can lead to problems (Roelz et al, 2016;Yoshihara and Yoneoka, 2014) and entail a higher rate of complications (Fessler and Sturgill, 1998;Yoshihara and Yoneoka, 2014). In general, an attempt is made to achieve adequate results and reduce problems with minimally invasive modifications (Kasliwal and Deutsch, 2011;Rosenthal, 2000;Snyder et al, 2014).…”