Lateral Extracavitary Approach to the Spine for Thoracic Disc Herniation: Report of 23 Cases

Maiman, Dennis J.; Larson, Sanford J.; Luck, Elizabeth A.; El-Ghatit, A.

doi:10.1227/00006123-198402000-00010

Cited by 175 publications

(93 citation statements)

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“…The predominant central location of HTHD in this series is consistent with literature findings [2,3,15,16,30]. For this reason, even posterior approaches enlarged with a costotransversectomy should be prohibited for this type of lesion [5,16,21,22,24,26,27]. Regarding a series of 15 surgical revisions after thoracic discectomy, Dickman et al found 13 calcified central herniated discs and stressed the importance of the anterolateral approach to this type of lesion for a complete excision with less risk of neural injury [16].…”

Section: Discussionsupporting

confidence: 87%

Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy

et al. 2006

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The authors retrospectively reviewed a series of 18 hard thoracic herniated discs (HTHD) operated by thoracoscopy. Isolated cases of HTHD have been reported in the literature, but no series describing these lesions has been published. Seventy-two percent of the herniated discs were situated between T8 and T12. Fifty-six percent of the patients had radiographic sequelae of Scheuermann's disease. Postoperatively, 83% had neurological improvement. In seven cases (39%), a plane separating the herniated disc and the dura mater was found surgically. In 11 patients, no separating plane was found during surgery. The lesion was intradural in three patients (17%) and adherent to the dura mater in eight (44%). Among these 11 patients, surgery was complicated by a dural tear in the first seven that led to a high risk of cerebrospinal fluid fistula: four of these seven patients had required surgical revision. In the last four, the zone of adhesion of the HTHD to the dura mater was preserved, successfully preventing dural tear Keywords Calcified thoracic disc herniation AE MRI AE Scheuermann AE Thoracic spine AE Thoracoscopy Eur Spine J (2006) 15: 537-542

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Section: Discussionsupporting

confidence: 87%

Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy

et al. 2006

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“…There is no gold standard approach and each technique has unique advantages and disadvantages [7,8]. These approaches include transpedicular, transfacet pedicle-sparing approaches, costotransversectomy, transthoracic transpleural approach, thoracoscopic approach [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Calcified giant thoracic disc herniations: considerations and treatment strategies

et al. 2014

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Introduction Giant herniated thoracic discs (GHTD) remain a surgical challenge. When combined with calcification, these discs require altered surgical strategies and have only been infrequently described. Our objective was to describe our surgical approaches in the management of calcified GHTD. Methods This was a retrospective cohort study of all patients with calcified GHTD operated between 2004 and 2012. Data were collected from review of patients' notes and radiographs and included basic demographic and radiological data, clinical presentation and outcome, operative procedure and complications. Results During the study period, there were 13 patients with calcified GHTD, including 6 males and 7 females (mean age 55 years, range 31-83 years). The average canal encroachment was 62 % (range 40-90 %); mean follow-up 37 months (12-98). All patients were treated with anterior thoracotomy, varying degrees of vertebral resection, removal of calcified disc and with or without reconstruction. The average time for surgery was 344 min (range 212-601 min) and estimated blood loss 1,230 ml (range 350-3,000 ml). Post-operatively, 8 patients improved by 1 Frankel grade (62 %), 2 improved by 2 grades (15 %) and 3 did not change their grade (23 %). The complication rate was 4/13 (31 %; 3 patients with durotomies (2 incidental, 1 intentional) and 1 with recurrence). Discussion Calcified GHTD remain a surgical challenge. Anterior decompression through a thoracotomy approach, and varying degrees of vertebral resection with or without reconstruction allowed us to safely remove the calcified fragment. All patients remained the same (23 %) or improved by at least 1 grade (77 %) neurologically, without radiographic failure at final follow-up.

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“…This technical advantage has led to excellent neurological outcomes with nearly 75% of patients described in the literature demonstrating neurological improvement. 1,8,9,16,20,21 Furthermore, Maiman et al reported significant neurological improvement following late anterior decompression with restoration of a normal anatomical relationship of the spinal cord and spinal canal using the LECA in patients previously treated with laminectomy or spinal instrumentation, or both. 20 Pain associated with thoracolumbar pathology also tends to respond well to the LECA, with approximately 85% of patients experiencing meaningful relief.…”

Section: Discussionmentioning

confidence: 99%

“…Eleven of the 63 articles (62 from the PubMed search, 1 from manuscript citations) were included in the LECA Summary Table (Table 1). 1,4,8,9,14,16,[19][20][21][22]26 The LECA Summary Table (Table 1) details the included studies. Study design, class of medical evidence, number of patients, levels of pathology, type of pathology, neurological outcome, pain outcome, and complications were included when mentioned in the original text.…”

Section: Systematic Reviewmentioning

confidence: 99%

The lateral extracavitary approach to the thoracolumbar spine: a case series and systematic review

Foreman¹,

Naftel

Moore

et al. 2016

SPI

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OBJECT Since its introduction in 1976, the lateral extracavitary approach (LECA) has been used to access ventral and ventrolateral pathology affecting the thoracolumbar spine. Reporting of outcomes and complications has been inconsistent. A case series and systematic review are presented to summarize the available data. METHODS A retrospective review of medical records was performed, which identified 65 consecutive patients who underwent LECA for the treatment of thoracolumbar spine and spinal cord pathology. Cases were divided according to the presenting pathology. Neurological outcomes and complications were detailed. In addition, a systematic review of outcomes and complications in patients treated with the LECA as reported in the literature was completed. RESULTS Sixty-five patients underwent the LECA to the spine for the treatment of thoracic spine and spinal cord pathology. The most common indication for surgery was thoracic disc herniation (23/65, 35.4%). Neurological outcomes were excellent: 69.2% improved, 29.2% experienced no change, and 1.5% were worse. Two patients (3.1%) experienced a complication. The systematic review revealed comparable neurological outcomes (74.9% improved) but a notably higher complication rate (32.2%). CONCLUSIONS The LECA provides dorsal and unilateral ventrolateral access to and exposure of the thoracolumbar spine and spinal cord while allowing for posterior instrumentation through the same incision. Although excellent neurological results can be expected, the risk of pulmonary complications should be considered.

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Lateral Extracavitary Approach to the Spine for Thoracic Disc Herniation: Report of 23 Cases

Cited by 175 publications

References 0 publications

Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy

Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy

Calcified giant thoracic disc herniations: considerations and treatment strategies

The lateral extracavitary approach to the thoracolumbar spine: a case series and systematic review

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