Mini–Open Retropleural Transthoracic Approach for the Treatment of Giant Thoracic Disc Herniation

Moran, Catherine; Ali, Zulfiqar; McEvoy, Linda; Bolger, Ciarán

doi:10.1097/brs.0b013e3182574657

Cited by 59 publications

(57 citation statements)

References 17 publications

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“…Both anterior and posterior surgical techniques have been described for the surgical management of thoracic disc herniations [4,6,[26][27][28]31]. The anterior approach provides good visualisation and surgical access but carries potential morbidity associated with thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

“…This subgroup displayed unique clinical presentation, surgical considerations and outcome as compared to small and medium size HTDs [4]. Until recently, there were no articles on this complex problem [4][5][6]. The surgical difficulty is greatly affected by the large volume and calcified nature of the herniated disc.…”

Section: Introductionmentioning

confidence: 99%

“…The surgical difficulty is greatly affected by the large volume and calcified nature of the herniated disc. Given that these patients tend to present with myelopathy with an already compromised spinal cord, absolute care in surgical planning and procedure is paramount [6].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Calcified giant thoracic disc herniations: considerations and treatment strategies

et al. 2014

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“…This information guides the surgical technique required to remove the disc and allows the surgeon to predict complications such as dural tear, avoid this and utilise a planned durotomy around the lesion. Both anterior and posterior surgical techniques have been described for the surgical management of thoracic disc herniations [1,[4][5][6][7]. The anterior approach provides good visualisation and surgical access, but carries potential morbidity associated with thoracotomy.…”

Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

“…The anterior approach provides good visualisation and surgical access, but carries potential morbidity associated with thoracotomy. A mini-thoracotomy with microsurgical decompression may decrease the approach-related morbidity [1,7]. Posterior laminectomy for thoracic discectomy has been associated with unsatisfactory results since first reported by Logue [8].…”

Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision

et al. 2013

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Background Thoracic cerebrospinal fluid (CSF) hygroma is a rare and potentially devastating complication of the anterior thoracic approach to the spine. We present two cases in which this complication resulted in acute cranial nerve palsy and discuss the pathoanatomy and management options in this scenario. Case reports Two male patients presented to our department with neurological deterioration due to a giant herniated thoracic disc. The extruded disc fragment was noted preoperatively to be calcified in both patients. A durotomy was performed at primary disc prolapse resection in the first patient, whereas an incidental durotomy during the

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

et al. 2018

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Surgery for thoracic disc herniation and spinal stenosis is comparatively rare and often demanding. The goal is to achieve sufficient decompression without manipulating the spinal cord. Individual planning and various surgical techniques and approaches are required. This anatomical study examines the feasibility of a novel full-endoscopic uniportal technique with a transthoracic retropleural approach for decompression of the anterior thoracic spinal canal. Operations were performed on three fresh adult cadavers. The endoscope used, from RIWOspine, Germany, has a shaft cross-section of 6.9 × 5.9 mm and a 25° view angle. It contains an eccentric intraendoscopic working channel with a diameter of 4.1 mm. A transthoracic retropleural approach was used. The anatomical structures were dissected and the anterior thoracic epidural space was decompressed. The planned steps of the operation were performed on all cadavers. The transthoracic retropleural approach allowed the target region to be accessed easily. The anatomical structures could be identified and dissected. The anterior thoracic epidural space could be decompressed sufficiently. Using the uniportal full-endoscopic operation technique with a transthoracic retropleural approach, the anterior thoracic epidural space can be adequately reached. This is a minimally invasive method with the known advantages of an endoscopic technique under continuous irrigation. The retropleural approach allows direct access. The instruments are available for clinical use and have been established for years in other operations on the entire spine. Clin. Anat. 31:716-723, 2018. © 2018 Wiley Periodicals, Inc.

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Mini–Open Retropleural Transthoracic Approach for the Treatment of Giant Thoracic Disc Herniation

Cited by 59 publications

References 17 publications

Calcified giant thoracic disc herniations: considerations and treatment strategies

Calcified giant thoracic disc herniations: considerations and treatment strategies

Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision

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

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