Is There a Place for the Posterior Approach in Cases of Acute Myelopathy on Thoracic Disc Hernia?

Brauge, David; Madkouri, Rachid; Reina, Vincent; Bennis, S.; Baussart, Bertrand; Mireau, Étienne; Aldéa, Sorin; Gaillard, Stéphan

doi:10.1016/j.wneu.2017.08.100

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…Apparently a sole dorsal decompression provided a short relieve for the spinal cord. This phenomenon has also been described by a French group where emergency laminectomy stabilized a deteriorating neurological condition followed by definite resolution via the anterior approach [5]. In our series-after a mean of 2.8 years-symptoms worsened again.…”

Section: Discussionsupporting

confidence: 83%

“…Although successful in a number of cases, especially in stabilizing an acute deteriorating neurological condition [5], we believe that this inadequate visualization and exposure (by failing to create a large working space in the vertebral body) contributed to the spinal cord injuries (SCIs) that the two patients sustained during the original operations in which the posterolateral approaches were performed, as reported by other groups [4,11]. Transpedicular or posterolateral approaches may be indicated for the treatment of small, laterally positioned thoracic disc herniations [3,18,19].…”

Section: Discussionmentioning

confidence: 99%

“…Since introduction of the anterolateral approach 25 years ago-i.e. "the chop stick approach" (Ciaran Bolger), we still see reports emerging about the feasibility of variations of the posterolateral approach [2,5,16,17,34,35], but for the time being and comparing results achieved with other procedures, the chop stick approach is "the technique to beat".…”

Section: Discussionmentioning

confidence: 99%

“…Laminectomy was abandoned during the last 30 yearswith exceptions [4,5]-and anterolateral transthoracic approaches gained popularity [4,[6][7][8][9]. Adequate invasive techniques and instruments have been developed for thoracic and lumbar approaches popularizing the principle of approaching the thoracic spine anterolaterally.…”

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: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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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“…Currently, this technique is rarely used due to poor clinical outcomes (17, 23). Laminectomy without discectomy, on the other hand, can be applied in certain patients, especially for those who require acute decompression (9). In the present study, none of the patients who underwent laminectomy had neurologic deterioration, and they had neurologic improvement at the short-term follow-up.…”

Section: Complicationsmentioning

confidence: 45%

Surgical management of thoracic disc herniation: anterior vs posterior approach

Oltulu¹,

Çil²,

Sigurd³

et al. 2019

Turkish Neurosurgery

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AIM: To compare outcomes and complications in patients with thoracic disc herniation (TDH) undergoing surgery with either the posterior or anterior approach. MATERIAL and METHODS: A total of 86 patients, with 98 symptomatic TDHs, who underwent surgery in a single institution between 2007 and 2016, were included. Overall, 68 patients were in the anterior and 18 were in the posterior group. Ten patients underwent multilevel TDH surgery. RESULTS: The groups were similar in age, sex, body mass index, and clinical symptoms. In the anterior group, 4 patients (5.9%) had major complications, and 26 (38.2%) had minor complications. In the posterior group, 6 patients (33.3%) had major complications, and 4 (22.2%) had minor complications. Visual analog scores at the final follow-up improved in both groups as compared to baseline preoperative scores (p>0.05). The rate of neurological improvement in patients with myelopathy was significantly higher in the anterior group (43/50) than in the posterior group (8/14) (p<0.05). CONCLUSION: The current study showed that higher rates of major complications in central and calcified paracentral TDHs are associated with posterior approaches when compared to anterior approaches. In addition, anterior approaches had superior neurological recovery and clinical outcomes. Therefore, we recommend the anterior approach for the treatment of calcified and/or non-calcified central and calcified paracentral TDH, while reserving posterior approaches for small non-calcified paracentral disc herniations.

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