The Surgical Treatment of Thoracic and Thoracolumbar Disc Lesions Using the Anterior Approach

Otani, Kiyoshi; Manzoku, Shunichi; Shibasaki, Keiichi; Nomachi, Shozaburo

doi:10.1097/00007632-197712000-00005

Cited by 16 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These complications must be appreciated so that they can be avoided; comprehensive discussions of the approaches and their respective complications have been presented elsewhere. [1][2][3]5,7,9,10,14,17,[20][21][22][23]25,26,28,29,34,[36][37][38][39]41,[43][44][45]56,58,[60][61][62][63][64][65]67,68,69] No universally accepted selection criteria exist to help the surgeon choose the best operation for disc removal. Moreover, no single surgical approach is best suited for all situations.…”

Section: Variability Of Surgical Approachesmentioning

confidence: 99%

Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature

Stillerman¹,

Chen²,

Couldwell³

et al. 1998

FOC

110

View full text Add to dashboard Cite

Object The authors aimed to develop management strategies for the treatment of herniated thoracic discs and to define indications for selection of surgical approaches. Symptomatic thoracic discs requiring surgery are rare. Between 1971 and 1995, 71 patients with 82 herniated thoracic discs were surgically treated by the authors. The treated group included 34 men and 37 women whose ages ranged from 19 to 75 years, with a mean age of 48 years. The most common sites of disc herniation requiring surgery were from T-8 to T-11. Evidence of antecedent trauma was present in 37% of the patients. Preoperative symptoms included pain (localized, axial, or radicular) in 54 (76%) of the 71 patients, evidence of myelopathy that is, motor impairment in 43 (61%), hyperreflexia and spasticity in 41 (58%), sensory impairment 43 (61%), and bladder dysfunction in 17 (24%). Methods Radiological diagnosis for the patients in this series was accomplished by means of myelography, computerized tomography myelography, or magnetic resonance imaging. Classification of the disc location into two groups reveals that 94% were centrolateral and 6% were lateral. Evidence of calcification was present in 65% of patients, and in 7% intradural extension was noted at surgery. Ten patients (14%) were found to have multiple herniations. Four surgical approaches were used for the removal of these 82 disc herniations: transthoracic in 49 (60%), transfacet pedicle-sparing in 23 (28%), lateral extracavitary in eight (10%), and transpedicular in two (2%). Postoperative evaluation revealed improvement or resolution of pain in 47 (87%) of 54, hyperreflexia and spasticity in 39 (95%) of 41, sensory changes in 36 (84%) of 43, bowel/bladder dysfunction in 13 (76%) of 17, and motor impairment in 25 (58%) of 43. Complications occurred in a total of 12 (14.6%) of 82 discs treated surgically. Major complications were seen in three patients and included perioperative death from cardiopulmonary compromise, instability requiring further surgery, and an increase in the severity of a preoperative paraparesis. Conclusions Review of this series, with the attendant complications, together with evaluation of several contemporary thoracic disc series, has facilitated the authors' decision-making process when considering the comprehensive management of these patients, including the selection of a surgical approach.

show abstract

Section: Variability Of Surgical Approachesmentioning

confidence: 99%

Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature

Stillerman¹,

Chen²,

Couldwell³

et al. 1998

FOC

110

View full text Add to dashboard Cite

show abstract

“…Because of the unacceptable morbidity and poor results of posterior decompression via laminectomy [17,18,34] in the treatment of TDH [17], a number of alternative surgical approaches have been developed including posterior transdural [21], tailored posterior [3], oblique paraspinal [5], posterolateral (transpedicular [14,16,24], transfacet pedicle sparing [25,32], transcostovertebral [7], costotransversectomy [11,29]), lateral (lateral extracavitary [19]), anterolateral (transthoracic [2,6,8,22,23], thoracoscopic [12,27]), and anterior (transsternal [33], mini-thoracotomy [28]), as well as other transthoracic approaches [20].…”

Section: Introductionmentioning

confidence: 99%

Transthoracic approach for the treatment of calcified giant herniated thoracic discs

et al. 2013

View full text Add to dashboard Cite

Objective This study aimed at reporting the results of a transthoracic approach in the treatment of patients with calcified giant herniated thoracic discs (HTDs). Methods Fifteen consecutive patients, 11 males and 4 females with a mean age of 46 years (range 33-61), with calcified giant HTDs underwent transthoracic decompression and segmental instrumentation with interbody fusion from November 2004 to September 2010. Clinical data retrospectively examined and compared were levels and types of disc herniation, operative time, blood loss, preand postoperative Frankel grades and Japanese Orthopedic Association (JOA) score, and complications. Results Of the 15 patients, 2 had HTDs at two levels and affected discs were primarily at the T11/12 level (60 %). Presenting symptoms included myelopathy, axial back pain, urinary symptoms, and radiculopathy. Disc herniations were classified as central (40 %) or paracentral (60 %). All discs were successfully removed without dural tears or cerebral spinal fluid leakage. The mean operation time was 179 ± 27 min (range 140-210 min), and the mean estimated blood loss was 840 ± 470 ml (range 300-2,000 ml). Frankel grades improved in 9 patients postoperatively and 12 patients at the last follow-up. The mean JOA score improved from 4.9 to 7.7. All patients reported improvement in symptoms. The average duration of follow-up was 45 ± 24 months (range 7-77 months). Conclusions Transthoracic decompression combined with reconstruction, fusion, and fixation is an effective method for the treatment of these lesions and is associated with a low rate of complications, morbidity, and neurological impairment.

show abstract

“…[1][2][3][4][5][6][7]9,13,17,18,20,25,35,37,[40][41][42] A number of operative techniques have evolved in the treatment of herniated thoracic discs, including the transthoracic, [10,12,14,15,[28][29][30]33,34,[37][38][39][40][41][42] lateral extracavitary, [16,23,26,[40][41][42] and transpedicular approaches. [24,31,32,[40][41][42] These procedures have allowed surgeons to safely remove herniated discs, including central osteophytes and intradural fragments.…”

Section: Abstract * Thoracic Spine * Thoracic Disc * Intervertebral mentioning

confidence: 99%

“…The exposure to the disc space provided by the anterolateral [10,12,14,15,28,33,34,38,[40][41][42] and lateral (lateral extracavitary) [14,22,23,26,[40][41][42] approaches is excellent (Fig. 6 left and center).…”

Section: Comparison Of Transfacet Approach With Other Techniques For mentioning

confidence: 99%

The transfacet pedicle-sparing approach for thoracic disc removal: cadaveric morphometric analysis and preliminary clinical experience

Stillerman¹,

Chen²,

Day³

et al. 1998

FOC

View full text Add to dashboard Cite

A number of operative techniques have been described for the treatment of herniated thoracic discs. The transfacet pedicle-sparing approach allows for complete disc removal with limited spinal column disruption and soft-tissue dissection. Fifteen cadaveric spinal columns were used for evaluation of exposure, development of thoracic microdiscectomy instrumentation, and establishment of morphometric measurements. This approach was used to remove eight thoracic discs in six patients. Levels of herniation ranged from T-7 through T-11. Preoperatively, all patients had moderate to severe axial pain, and three (50%) of the six had radicular pain. Myelopathy was present in four (67%) of the six patients. Through a 4-cm opening, the ipsilateral paraspinal muscles were reflected, and a partial facetectomy was performed. The disc was then removed using specially designed microscopic instrumentation. Postoperatively, the radiculopathy resolved in all patients. Axial pain and myelopathy were completely resolved or significantly improved in all patients. The minimal amount of bone resection and muscle dissection involved in the operation allows for: 1) decreased operative time and blood loss; 2) diminished perioperative pain; 3) shorter hospitalization time and faster return to premorbid activity; 4) avoidance of closed chest tube drainage; and 5) preservation of the integrity of the facet-pedicle complex, with potential for improvement in outcome related to axial pain. This technique appears best suited for the removal of all centrolateral discs, although it has been used successfully for treating a disc occupying nearly the entire ventral canal. The initial experience suggests that this approach may be used to safely remove appropriately selected thoracic disc herniations with good results.

show abstract

The Surgical Treatment of Thoracic and Thoracolumbar Disc Lesions Using the Anterior Approach

Cited by 16 publications

References 0 publications

Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature

Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature

Transthoracic approach for the treatment of calcified giant herniated thoracic discs

The transfacet pedicle-sparing approach for thoracic disc removal: cadaveric morphometric analysis and preliminary clinical experience

Contact Info

Product

Resources

About