The Natural History of Asymptomatic Thoracic Disc Herniations

Wood, Kirkham B.; Blair, John M.; Aepple, Dorothee M.; Schendel, Michael J.; Garvey, Timothy A.; Gundry, Cooper R.; Heithoff, Kenneth B.

doi:10.1097/00007632-199703010-00011

Cited by 110 publications

(55 citation statements)

References 16 publications

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“…Better clinical awareness and radiological advances have resulted in an increased diagnostic incidence of thoracic disc disease, which is commonly seen between 3rd and 6th decades [4,18,19]. The natural history of HTD suggests that it may remain asymptomatic for a long time [19], during which time it may enlarge but it rarely presents as acute myelopathy [19].…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Calcified giant thoracic disc herniations: considerations and treatment strategies

et al. 2014

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“…Moreover, they are often accompanied by the so-called nuclear trial sign which suggests a migratory path at the level of the intervertebral disc or endplate and may be another finding consistent with a growth disturbance [1]. On the other hand, some thoracic disc herniations have been shown to appear de novo as well [20].…”

Section: Discussionmentioning

confidence: 99%

Two brothers with a symptomatic thoracic disc herniation at T11–T12: clinical report

et al. 2009

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“…In some people, conservative treatment has shown to be effective for patients Correspondence: Do Heum Yoon, M.D., Ph.D, Department of Neurosurgery, College of Medicine, Yonsei University, Seoul 120-752, Korea. e-mail: ydoheum@yumc.yonsei.ac.kr without long-tract clinical signs [7,25], but there is no doubt that surgical treatment is required for patients with severe or progressive myelopathy.…”

Section: Introductionmentioning

confidence: 99%

Outcome of surgery for a symptomatic herniated thoracic disc in relation to preoperative characteristics of the disc

Kim

Shin

et al. 2007

Acta Neurochir (Wien)

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SummaryBackground. This report presents general information on herniated thoracic discs, their clinical manifestations as well as surgical treatment, and examines the differences in the surgical outcome based on disc characteristics.Methods. This study includes 33 thoracic discectomies in 29 patients with a ventrally situated herniated thoracic disc reaching to the thoracic cord. Using preoperative computed tomography scanning and magnetic resonance imaging, the direction of the disc was classified as either central or lateral, and disc consistency classified as either soft or hard. Clinical outcome was assessed according to the Japanese Orthopedic Association (JOA) Score for thoracic myelopathy. The score was obtained by analysing motor, sensory and bladder function. Recovery rate was assessed, comparing preoperative and postoperative status based on disc characteristics. The correlations between outcome, symptom duration and recovery rate were also investigated.Findings. Clinical outcome according to the JOA Score showed significant postoperative improvement, increasing from 7.0 AE 3.1 points to 8.2 AE 2.7 points postoperatively (p < 0.01). The mean recovery rate was 12.4 AE 56.9%, and 16 patients (55.2%) showed improvement. In the soft disc group, there was improvement in all categories, but the hard disc group showed no improvement. The central disc group showed improvement

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The Natural History of Asymptomatic Thoracic Disc Herniations

Cited by 110 publications

References 16 publications

Calcified giant thoracic disc herniations: considerations and treatment strategies

Calcified giant thoracic disc herniations: considerations and treatment strategies

Two brothers with a symptomatic thoracic disc herniation at T11–T12: clinical report

Outcome of surgery for a symptomatic herniated thoracic disc in relation to preoperative characteristics of the disc

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