Transthoracic Surgical Treatment for Centrally Located Thoracic Disc Herniations Presenting With Myelopathy

Abstract

Thoracotomy for treatment of centrally located thoracic disc herniations is associated with improvement in or stabilization of myelopathic symptoms in the majority of patients with an acceptable rate of complications. Interestingly, most patients with weakness improved in strength (12/16, 75%), no patients with normal strength developed new weakness (10/10, 100%), and only 2 patients had new weakness noted postoperatively (7.4%).

Iatrogenic spinal cord injury: an observational study

“…Martín et al 5 found an incidence of 11.3%. As for the thoracic level, Ayhan et al 4 noted worsening on the ASIA scale of 7.4% of the patients.…”

“…2 In literature, there are series of isolated cases, although very few general reviews covering the various etiologies of iatrogenia in SCI, which focus especially in surgical treatment. The causes found are the following: Surgical: laminectomy, 3 discectomy, 4 arthrodesis, 5,6 scoliosis, 7 exeresis of calcified yellow ligaments, 8 vascular surgery, 9,10 use of surgicel. 11,12 Interventionist techniques: vertebroplasty, 13 arterial embolization, 14 epidural anesthesia, 15 intramuscular injections, 16 acupuncture.…”

Mini-Open Transthoracic Approach for Resection of a Calcified Herniated Thoracic Disc and Repair of the Dural Surface with Fibrin Glue: A Case Report

“…18 The anterior open transthoracic approach provides optimal ventral exposure and has been recommended. 7,8,10,18,19 The use of a microscope to remove the calcified herniated disc under direct vision was safe and resulted in limited bone excision and thus avoided the need for fusion surgery. The use of an endoscope or microscope in a minimally invasive procedure has been reported.…”

“…[3][4][5] Surgical treatment for calcified thoracic disc herniation is challenging. [6][7][8][9][10] Calcified lesions are often voluminous and adherent to the ventral dura mater. Despite development of numerous techniques, appropriate surgical procedures remain controversial.…”

“…Despite development of numerous techniques, appropriate surgical procedures remain controversial. [8][9][10][11][12][13] Complications after thoracic spinal surgery include pulmonary complications, neurological deficits, and cerebrospinal fluid (CSF) leakage. The overall complication rate after thoracoscopic treatment for thoracic disc herniation has been reported to be 15.6%, and dural tear occurred in 2 (1.2%) patients.…”