The Clinical Syndromes and Surgical Treatment of Thoracic Intervertebral Disc Prolapse

Abstract

Doubt remains as to the safest surgical approach to the prolapsed thoracic intervertebral disc. Laminectomy, lateral rhachotomy and the transthoracic approach all have their protagonists. Twenty-two patients from the National Hospital for Nervous Diseases, Queen Square, and Atkinson Morley's Hospital have been reviewed. Their clinical presentation is discussed and the ancillary aids to diagnosis assessed. The diagnostic value of disc space calcification is stressed, and the use of air myelography as an adjunct to positive contrast myelography is noted. Fifteen patients were subjected to laminectomy, and seven to lateral rhachotomy. Each group contained patients with a wide range of neurological deficit. Six of the patients who underwent laminectomy were improved, two were unchanged, six deteriorated and one died. Of the patients who had lateral rhachotomy, six were improved, one was unchanged and none deteriorated. The conclusion is drawn that lateral rhachotomy is a safer procedure.

Paraplegia as a sequela to dorsal disc prolapse

“…Unlike lumbar disc syndromes which typically present with radicular signs and symptoms, there are no symptoms or signs that are 'characteristic' of cord com pression in the dorsal region and the symptoms in these cases are not materially different from those of neoplasm except for the traumatic cases (Logue, 1952). These varying manifestations have been confused with pleurodynia, intercostal neuritis, intra-abdominal disease, neoplasm, arachnoiditis, disseminated sclerosis, oesophagitis and even familial ataxia and polymyalgia rheumatica (Love and Kiefer, 1950;Miiller, 1951;Logue, 1952;Abbott and Retter, 1956;Shaw, 1975;Benson and Byrnes, 1975;Hodges and Barry, 1975).…”

Postfixed Brachial Plexus Radiculopathy Due to Thoracic Disc Herniation in a Collegiate Wrestler: A Case Report

“…[18][19][20] High-level thoracic disc herniation (T1-T4) is very uncommon, with T1-T2 disc herniations accounting for less than 6% of all thoracic disc herniations. [18][19][20][21][22][23][24][25][26] In a review of 280 thoracic disc herniations, Arce and Dohrmann 20 found only 25% of patients had histories of trauma but noted that symptoms lasting more than 24 hours but less than 1 month and including signs of spinal cord compression or radicular symptoms were almost always associated with a history of trauma. Similarly, Abbed and Coumans 3 reported acute cervical radiculopathy in younger patients is more likely due to intervertebral disc injury.…”

“…High-level thoracic disc herniations, which occur from T1-T4, are exceedingly uncommon. [18][19][20][21][22][23][24][25][26] We present the case of a 23-year-old male collegiate wrestler who sustained what appeared to be a C7 brachial plexus traction injury but ultimately was diagnosed with a T1-T2 thoracic disc herniation impinging a postfixed brachial plexus that required surgical intervention. Given the rarity of T1-T2 disc herniation, we believe this case illustrates the importance of understanding the common anatomic variations of the brachial plexus to aid in proper diagnosis and appropriate treatment of these conditions, especially when the response to treatment does not progress as anticipated.…”

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

“…While it is difficult to estimate the actual number of dorsal disc protrusions that needed excision during the period of this study the notable fall in the overall incidence of paraplegia following dorsal discectomy as seen in the National Spinal Injuries Centre, suggests a change in the morbidity rate associated with this procedure. There are confusing and often conflicting accounts on the merits of laminectomy for dorsal disc protrusion in the medical literature (Singounas et (Hulme, 1960) or postero lateral decompression (Benson et at., 1975). In our review the fact that very few patients with dorsal disc protrusion had neurological complications in association with either costotransversectomy or posterolateral decompression (Table 4) may suggest a better prognosis with these surgical procedures compared with laminec tomy.…”