Background: Transthoracic discectomy is an established surgical procedure for the treatment of thoracic disk disease. Most authors advocate interbody fusion after transthoracic discectomy. The purpose of this study was to determine if there were any adverse consequences in foregoing interbody fusion after transthoracic discectomy.
Methods: Eighteen consecutive patients underwent transthoracic discectomy without fusion between 1996 and 2002 at Mayo Clinic (Rochester, MN). There were 11 women and 7 men with the mean age of 54 years (range, 28-84 years). Surgical indications were radiculopathy in 1 patient and myelopathy in 17. Follow-up data were obtained from the clinic visits and telephone surveys. We used the available pre- and postoperative radiographs for 16 patients at the last follow-up to establish the incidence of postoperative kyphosis and/or scoliosis at the operated level. Mean duration of the radiographic follow-up was 22 +/- 24 (SD) months.
Results: None of the patients reported the onset of a new axial spine pain postoperatively. No patient developed segmental kyphosis or scoliosis at the operated level during the follow-up period. Fifteen of 18 (83%) patients had significant improvement in their neurological symptoms and signs. Two patients remained unchanged. An 83-year-old patient had a slight worsening of her gait after surgery. Specifically, the only 3 nonambulatory patients regained ambulation after discectomy. There were 4 complications: 1 wound infection, 1 pleural effusion requiring pleurodesis, 1 cerebrospinal fluid leak, and 1 case of disabling intercostal neuralgia.
Conclusions: These results indicate that interbody fusion may not be necessary for selected patients undergoing transthoracic discectomy. Further long-term follow-up is needed to evaluate the development of late spinal instability and resultant deformity after this procedure.
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http://dx.doi.org/10.1016/j.surneu.2004.06.026 | DOI Listing |
Cureus
August 2024
Neurosurgery, Temple University Hospital, Philadelphia, USA.
Symptomatic thoracic disc herniation (TDH) is relatively uncommon and can present with thoracolumbar pain, myelopathy, bladder dysfunction, and motor dysfunction. Midline TDHs and calcified discs are more challenging to access and treat compared to the cervical or lumbar region due to the narrow working corridor around the lungs, ribs, and thoracic spinal cord. Open approaches such as the transthoracic or retropleural approach are particularly morbid.
View Article and Find Full Text PDFActa Neurochir (Wien)
March 2024
Department of Neurosurgery, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
Purpose: A transthoracic anterior or lateral approach for giant thoracic disc herniations is a complex operation which requires optimal exposure and maximal visualisation. Traditional metal rigid retractors may inflict significant skin trauma especially with prolonged operative use and limit the working angles of endoscopic instrumentation at depth. We pioneer the use of the Alexis retractor in transthoracic thoracoscopically assisted discectomy for the first time.
View Article and Find Full Text PDFMedicina (B Aires)
December 2023
Servicio de Ortopedia y Traumatología Prof. Dr. Carlos E. Ottolenghi, Sector Patología del Raquis, Hospital Italiano de Buenos Aires, Argentina.
Thoracic disc herniation is a rare pathology compared to the rest of the herniated discs. Due to their difficult access to the area of compromise and proximity to the spinal cord they represent a real challenge for the spine surgeon. The objective is to report an atypical case with three symptomatic dorsal disc herniations which required surgical treatment.
View Article and Find Full Text PDFOper Neurosurg (Hagerstown)
November 2023
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Background And Objectives: Thoracic disk herniations are challenging to treat, and open transthoracic or minimally invasive thoracoscopic approaches are associated with significant morbidity, substantial costs, and steep learning curves. The minimally invasive lateral retropleural thoracic diskectomy (MIS-LRP-TD) approach is straightforward and is associated with lower perioperative morbidity. With MIS-LRP-TD, the overlying rib, ipsilateral pedicle, ligamentum flavum, posterior longitudinal ligament, and posterior third of the adjacent vertebral bodies are resected.
View Article and Find Full Text PDFClin Neurol Neurosurg
January 2024
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA. Electronic address:
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