Protrusion of Thoracic Intervertebral Disks with Compression of the Spinal Cord.

Müller, Ragnar

doi:10.1111/j.0954-6820.1951.tb17150.x

Cited by 41 publications

(6 citation statements)

References 6 publications

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“…Parallelly in the early 1950's, starting from similar observations, the surgical community kept interrogating about the best technical options for spinal cord decompression in case of thoracic disc herniation. According to the surgical experience of Logue (1952) 8 , purely posterior approach via laminectomy did provide in most cases total functional transection of the cord (5 out of 6 patients); in the same period, same conclusions were drawn by other authors (Hawk, 1936; Love and Kiefer, 1950; Muller, 1951) [8][9][10] .…”

Section: Accepted Manuscriptsupporting

confidence: 58%

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History of Evolution of Posterolateral Approaches to the Thoracic Spine: From Cure of Pott's Disease to Epidural Tumor Resection

Gagliardi

Pompeo

Domenico

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Since the end of the nineteenth century, the wide dissemination of Pott’s disease has ignited debates about which should be the ideal route to perform ventrolateral decompression of the dorsal rachis in case of paraplegia due to spinal cord compression in tuberculosis spondylitis. It was immediately clear that the optimal approach should be the one minimizing the surgical manipulation on both neural and extra-neural structures, while optimizing the exposure and surgical maneuverability on the target area. The first attempt was reported by Victor Auguste Menard in 1894, who described, for the first time, a completely different route from traditional laminectomy, called costotransversectomy. The technique was conceived to drain tubercular paravertebral abscesses causing paraplegia without manipulating the spinal cord. Over the following decades many other routes have been described all over the world, thus demonstrating the wide interest on the topic. Surgical development has been marked by the new technical achievements and by instrumental/technological advancements, until the advent of portal surgery and endoscopy-assisted techniques. Authors retraced the milestones of this history up to the present days, through a systematic review on the topic.

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Section: Accepted Manuscriptsupporting

confidence: 58%

“…According to the surgical experience of Logue (1952), 8 a purely posterior approach via laminectomy did provide total functional transection of the cord (5 of 6 patients) in most cases; in the same period, the same conclusions were drawn by other authors. 8 9 10…”

Section: Literature Reviewmentioning

confidence: 99%

History of Evolution of Posterolateral Approaches to the Thoracic Spine: From Cure of Pott's Disease to Epidural Tumor Resection

Gagliardi

Pompeo

Domenico

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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“…7 Other reports suggest a 75% paralysis rate and 25% death rate with aggressive retraction of the spinal cord for anterior decompression. 8…”

Section: Introductionmentioning

confidence: 99%

“…7 Other reports suggest a 75% paralysis rate and 25% death rate with aggressive retraction of the spinal cord for anterior decompression. 8 Alternative approaches to the disc space include the transpedicular, 9 costotransversectomy, 10 and lateral extracavitary, 11 all of which are associated with significant morbidity and provide limited access to central herniations. 9,10 Transthoracic approaches and video-assisted thoracoscopy have been used with high success rates for disc decompression but are associated with higher morbidity than posterior approaches 12 and the added complexity of the procedure.…”

Section: Introductionmentioning

confidence: 99%

Calcified Thoracic Disc Herniations in the Elderly: Revisiting the Laminectomy for Single Level Disease

Oitment

Kwok

Steyn

2018

Global Spine Journal

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Study Design: Retrospective case series. Objectives: Calcified thoracic disc herniations in the elderly present with a variety of clinical conditions and the treatment is a source of significant debate. Decompression of the disc space is done through anterior, lateral, posterolateral, and posterior approaches. There is significant morbidity of thoracic disc herniation and associated decompression. Methods: The present report is a case series of 8 elderly patients with calcified discopathy who received a simple laminectomy without decompression of the disc space. Results: Postoperatively, 5 patients mobilized independently, 2 with a walker, and 1 patient was nonambulatory. Two patients improved 1 ASIA (American Spinal Injury Association Impairment Scale) score, 1 patient improved 2 ASIA scores, and 3 patients had no change in ASIA score. Conclusion: In our experience, thoracic disc herniations require a technically difficult decompression and overall the complications are significant. We present a series of 8 patients who generally improved from a simple laminectomy and consider this a viable procedure for patients too unwell to undergo direct disc decompression.

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“…In the first surgical series of the 1950s and 1960s, the mortality rates were 50% with major morbidity rates up to 70%. 1,2,[6][7][8] These extremely high surgical risks motivated surgeons to improve their results via alternative surgical corridors. The concepts of the new approach are avoiding direct contact with the spinal cord using more lateral and even anterior routes to the thoracic disk.…”

mentioning

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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Protrusion of Thoracic Intervertebral Disks with Compression of the Spinal Cord.

Cited by 41 publications

References 6 publications

History of Evolution of Posterolateral Approaches to the Thoracic Spine: From Cure of Pott's Disease to Epidural Tumor Resection

History of Evolution of Posterolateral Approaches to the Thoracic Spine: From Cure of Pott's Disease to Epidural Tumor Resection

Calcified Thoracic Disc Herniations in the Elderly: Revisiting the Laminectomy for Single Level Disease

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

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