Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy

Abstract

The authors retrospectively reviewed a series of 18 hard thoracic herniated discs (HTHD) operated by thoracoscopy. Isolated cases of HTHD have been reported in the literature, but no series describing these lesions has been published. Seventy-two percent of the herniated discs were situated between T8 and T12. Fifty-six percent of the patients had radiographic sequelae of Scheuermann's disease. Postoperatively, 83% had neurological improvement. In seven cases (39%), a plane separating the herniated disc and the dura mater was found surgically. In 11 patients, no separating plane was found during surgery. The lesion was intradural in three patients (17%) and adherent to the dura mater in eight (44%). Among these 11 patients, surgery was complicated by a dural tear in the first seven that led to a high risk of cerebrospinal fluid fistula: four of these seven patients had required surgical revision. In the last four, the zone of adhesion of the HTHD to the dura mater was preserved, successfully preventing dural tear Keywords Calcified thoracic disc herniation AE MRI AE Scheuermann AE Thoracic spine AE Thoracoscopy Eur Spine J (2006) 15: 537-542

The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease

“…Gille et al reported 18 cases with hard thoracic herniated discs, 72 % of which were situated between T8 and T12, a region that overlaps with the thoracolumbar spine. They found that 56 % of these patients had sequelae of SD [13]. This was, to some extent, in accordance with our finding that 55.6 % of TLDH patients could be diagnosed with SD (Table 4), according to Sorensen's criteria, which Gille et al [13] also used.…”

“…They found that 56 % of these patients had sequelae of SD [13]. This was, to some extent, in accordance with our finding that 55.6 % of TLDH patients could be diagnosed with SD (Table 4), according to Sorensen's criteria, which Gille et al [13] also used. The reason, we included a control group of LDH patients is to prevent excessive sensitivity to the identification of SD.…”

“…The ''lumbar Scheuermann's'' was first described in 1957 by Edgren and Vaino as ''osteochondrosis juvenilis lumbalis''. Recently, it has gradually been noted that SD, including its atypical forms, is not uncommon, and indeed, radiological signs of it may be present in 18-40 % of the population [13]. The radiologic similarity between TLDH and SD made it attractive to assume that these two disorders have a close relationship, which could help to explain the etiology of TLDH.…”

“…The radiologic similarity between TLDH and SD made it attractive to assume that these two disorders have a close relationship, which could help to explain the etiology of TLDH. Although symptomatic TLDH in the context of SD has been recognized to occur [11,[13][14][15][16][17], the very limited number of cases reported made it difficult to judge whether the simultaneous occurrence of these two infrequent disorders is simply due to random association or is indicative of a more substantial relationship between the two.…”

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

“…The etiopathogenesis of thoracic disc herniations is largely unknown, but according to the literature they may be linked CT computerized tomography, MR magnetic resonance, T thoracic to trauma [9], Scheuermann's disease [6,15] or a degenerative back [10]. The young age of these brothers, both in their early thirties, and the similarity of their disc herniation, suggest a familial predisposition.…”