Paraplegia due to intervertebral disc lesions: a review of 57 operated cases

Ravichandran, G; Frankel, H L

doi:10.1038/sc.1981.30

Cited by 17 publications

(5 citation statements)

References 15 publications

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“…. 11,13 Several factors are thought to be responsible for these poor results. One factor is the difficulty of removing disk fragments anterior to the spinal cord without mechanical damage.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical Experience with Pedicle-Sparing Transfacet Approach for Thoracic Disk Herniation

Çelik

Samancı

Özkaya

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Purpose Thoracic disk herniation (TDH) is relatively uncommon. The surgical approach differs from lumbar or cervical disk herniations because serious complications are associated with the posterior approach in TDH. Various different approaches have been tried for the surgical removal of TDH, but most of them are cumbersome surgeries such as thoracotomy or thoracoscopic or anterior approaches with or without instrumentation. The requirement for a simplified, familiar, and less morbid surgery has motivated some new approaches. A pedicle-sparing transfacet approach (PSTA) was first described in 1995, but to date no sufficient clinical series has been presented in the literature to report on its feasibility and applicability along with complication and morbidity rates. Our objective was to assess the feasibility of the PSTA under microscopic visualization in a cumulative clinical series. Methods Twenty-eight consecutive patients with no response to medical/physical treatment with and without motor weakness of their lower extremities underwent the surgery for TDH via the PSTA under microscopic visualization by a senior neurosurgeon. Preoperative and postoperative low extremity muscle strength, sensation, reflex status, and visual analog scores (VAS), Nurick grades, and complications were recorded. Postoperative MRI within 24 hours was performed. The median follow-up period was 33 months. Results The patients consisted of 16 men and 12 women. The disk levels ranged from T8 to T12–L1. All but one patient received one-level surgery. One patient was operated on two levels. A total of 21 patients had paracentral disk herniations; the other 7 had central disk herniations. Postoperative MRI showed satisfactory removal of disk herniation in all but one patient. There was no infection, wrong level surgery, or incidental durotomy. Median VAS levels significantly improved after the operation from 7.4 to 2.3. The Nuric grades decreased from 2.7 to 1.6 after surgery. Conclusions The microsurgical PSTA is a safe and feasible technique with a significantly shorter surgeon's learning curve. The approach offers a wide surgical window; moreover, it can by increased by tilting the surgical table allowing satisfactory decompression of TDH. After PSTA, segmental instrumentation is not required.

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Section: Discussionmentioning

confidence: 99%

Microsurgical Experience with Pedicle-Sparing Transfacet Approach for Thoracic Disk Herniation

Çelik

Samancı

Özkaya

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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“…7,17,21 The small space available for the spinal cord in the thoracic segment, associated with poor blood supply, increases the risk of neurological worsening after surgical compression. [22][23][24] The most relevant criteria in choosing the best surgical approach are related to the clinical condition of the patient and the characteristics of the herniation. 14,25 The posterior approach laminectomy was widely used in the 50s, with catastrophic results and serious neurological worsening in 70% of cases.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Disc Herniation: Case Series and Protocol for Surgical Approaches

et al. 2016

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Objective To describe the surgical results of a prospective series of five patients operated according to an approach indication protocol. Methods: Patients were classified according to surgical risk: Group A (high risk) or B (low risk) and subsequently into subgroups according to characteristics of the herniation and ultimately the surgical approach was defined: A.1) calcified central herniations - thoracoscopy; A.2) soft lateral herniations - posterolateral approach; A.3) centrolateral herniations - partial calcification in lateral position - posterolateral approach; higher density central calcification - thoracoscopy; B.1) central or centrolateral calcified herniations - thoracotomy or thoracoscopy; B.2) soft lateral herniations - posterolateral approach. Results: The duration of symptoms ranged from 2 months to 3 years; the age bracket was from 37 to 58 years; sex distribution was 3 female and 2 male patients and the length of hospital stay ranged from 2 to 20 days. The most affected level was T11/12. A patient classified as Group A.3 underwent posterolateral approach. The remaining patients were Group B.1, 3 submitted to thoracotomy and 1 to thoracoscopy. The herniation removal was completed in 5 cases; 3 patients improved and 2 remained stable. The morbidity and the recovery time were higher in patients who underwent anterolateral approaches. Conclusions: Classify patients according to surgical risk and the anatomical characteristics of disc herniation allows for complete decompression, minimizing morbidity and mortality.

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“…Some patients eventually require surgery [1]. Surgery can provide great improvement, but can sometime lead to serious complications such as hypovolemic shock by iliac artery injury and paraplegia by spinal cord injury [2,3]. Furthermore, failed back surgery syndrome most often follows surgery for disk herniation [4].…”

Section: Introductionmentioning

confidence: 99%