Multiple thoracic disc herniations: case report and review of the literature

Okada, Yusaku; Shimizu, Katsuji; Ido, Kazuhiro; Kotani, Shimpei

doi:10.1038/sj.sc.3100357

Cited by 42 publications

(34 citation statements)

References 18 publications

(28 reference statements)

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“…Some authors reported that anterior or antero-lateral discectomy may be the simplest and most effective method for disc excision and relief of spinal cord. 4,13,14 Furthermore, Vanichkachorn and Vaccaro 6 reported that posterior laminectomy was controversial for the treatment of symptomatic thoracic disc protrusions and recommended that the operative procedure must be chosen carefully among the anterior, lateral and posterior approaches. The avoidance of the posterior approach might be related to the fact that posterior laminectomy of the thoracic spine characterized by kyphosis would not successfully lead to decompression of the spinal cord compressed by posterior bulged disc and, furthermore, the spinal cord could be easily damaged when performing disc removal via posterior Figure 2 The excised sequestrated disc was a ring-like form.…”

Section: Discussionmentioning

confidence: 99%

Upper thoracic disc herniation followed by acutely progressing paraplegia

2005

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Study design: Case report. Objective: To report a rare thoracic intervertebral disc herniation followed by acutely progressing paraplegia. Setting: Spinal Injuries Center, Fukuoka, Japan. Method: A 37-year-old man presented with sudden severe backache and acutely progressing motor impairments of both lower extremities after antecedent backache lasting about 5 days. Neurological examination showed analgesia and hypoesthesia below the T4 dermatome level, dysesthesia to pinprick below right inguinal level, and severe motor impairments of the lower extremities (Frankel classification C). Magnetic resonance (MR) imaging demonstrated spinal cord compression due to a postero-laterally existing epidural mass at the T2-T3 level. After laminectomy at the T2-T3 level, the sequestrated disc material was detected and excised as one piece through the right side of the dura. The excised herniated mass had a ring-like form and was thought to originate from the annulus fibrosis. Result: After the emergency surgery, he had complete relief from the backache and control of both lower extremities recovered gradually. At 4 weeks after the emergent operation, motor power of both lower extremities recovered almost completely. He was able to walk without any assistance. MR imaging study after surgery did not reveal the sequestrated mass, except for a mild disc bulging at the T2-T3 level. Conclusion: Accurate diagnosis of acute symptomatic thoracic disc herniation is occasionally difficult. However, timely and successful surgery could result in complete symptom relief and satisfactory results.Spinal Cord (2005) 43, 741-745.

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Section: Discussionmentioning

confidence: 99%

Upper thoracic disc herniation followed by acutely progressing paraplegia

2005

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“…Symptomatic herniated thoracic discs (HTDs) account for only 0.15-1.8 % of all intervertebral disc abnormalities treated surgically [1][2][3]. Hott et al [4] defined giant herniated thoracic discs as those ''occupying more than 40 % of the spinal canal based on pre-operative computed tomography (CT) myelography, magnetic resonance imaging (MRI) or both''.…”

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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“…Compared with the literature, only 15 patients undergoing noncontiguous, multiple-level HTD decompression have previously been reported. 4,7,11,22,28,34,35 In addition, when considering our global cohort of patients with single-level and multiple-level HTDs, a substantial number of HTDs (n = 59) were deemed asymptomatic and nonoperative. Therefore, all surgical HTDs in myelopathic patients abutted, distorted, and deformed the spinal cord, while the surgical HTDs in radiculopathic patients correlated to the level of symptomatology.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…4,8,15 Anterolateral approaches, consisting of thoracotomy or thoracoscopy, best address large, midline, calcified disc herniations. 10,16,28,34,35,39,45 We report our experience on the management of patients with multiple-level symptomatic HTDs, treated via thoracotomy, thoracoscopy, and/or posterolateral approaches. Patient characteristics, surgical variables, and outcomes are compared among the different approaches and also to those of an unmatched cohort of patients undergoing single-level HTD decompression.…”

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confidence: 99%

Surgical management and clinical outcomes of multiple-level symptomatic herniated thoracic discs

Oppenlander¹,

Clark²,

Kalyvas³

et al. 2013

SPI

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Object Symptomatic herniated thoracic discs (HTDs) are rare, and patients infrequently require treatment of 2 or more disc levels. The authors assess the surgical management and outcomes of patients with multiple-level symptomatic HTDs. Methods A retrospective review of a prospectively maintained database was performed of 220 consecutive patients treated surgically for symptomatic HTDs. Clinical and surgical results were compared between patients with single-level disease and patients with multiple-level disease and also among the different approaches used for surgical decompression. Results Between 1992 and 2012, 56 patients (mean age 48 years; 26 male, 30 female) underwent 62 procedures for 130 HTDs. Forty-six patients (82%) had myelopathy, and 36 (64%) had thoracic radiculopathy; 24 patients had both conditions in varying degree. Symptom duration averaged 28 months. The surgical approach was dictated by disc size, consistency, and location. Twenty-three thoracotomy, 26 thoracoscopy, and 13 posterolateral procedures were performed. Five patients required a combination of approaches. Patients underwent 2-level (n = 44), 3-level (n = 7), 4-level (n = 4), or 5-level (n = 1) discectomies. Instrumented fusion was performed in 36 patients (64%). Thirteen patients harbored 19 additional discs, which were deemed asymptomatic/nonoperative. The mean hospital stay was 6.5 days. Complete disc resection was verified with postoperative imaging in every patient. The procedural complication rate was 23%, and the nature of complications differed based on approach. No patients had surgery-related spinal cord injury or new myelopathy. At a mean follow-up of 48 months, myelopathy and radiculopathy had resolved or improved at a rate of 85% and 92%, respectively. Using a general linear model, preoperative symptom duration (p = 0.037) and perioperative hospital length of stay (p = 0.004) emerged as negative predictors of myelopathy improvement. Most patients (96%) were satisfied with the surgical results. Compared with 164 patients who underwent single-level HTD decompression, patients requiring surgery for multiple-level HTDs were more often myelopathic (p = 0.012). Surgery for multiple-level HTDs was more likely to require a thoracotomy approach (p = 0.00055) and instrumented fusion (p < 0.0001) and resulted in greater blood loss (p = 0.0036) and higher complication rates (p = 0.0069). The rates of resolution for myelopathy (p = 0.24) and radiculopathy (p = 1.0), however, were similar between the 2 patient groups. Conclusions The management of multiple-level symptomatic HTDs is complex, requiring individualized clinical decision making. The surgical approaches must be selected to minimize manipulation of the compressed thoracic spinal cord, and a patient may require a combination of approaches. Excellent surgical results can be achieved in this unique and challenging patient population.

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Multiple thoracic disc herniations: case report and review of the literature

Cited by 42 publications

References 18 publications

Upper thoracic disc herniation followed by acutely progressing paraplegia

Upper thoracic disc herniation followed by acutely progressing paraplegia

Calcified giant thoracic disc herniations: considerations and treatment strategies

Surgical management and clinical outcomes of multiple-level symptomatic herniated thoracic discs

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