Revision surgery in thoracic disc herniation

Abstract

Purpose Surgical treatment failures or strategies for the reoperation of residual thoracic disc herniations are sparsely discussed. We investigated factors that led to incomplete disc removal and recommend reoperation strategies. Methods As a referral centre for thoracic disc disease, we reviewed retrospectively the clinical records and imaging studies before and after the treatment of patients who were sent to us for revision surgery for thoracic disc herniation from 2013 to 2018. Results A total of 456 patients were treated from 2013 to 2018 at our institution. Twenty-one patients had undergone previously thoracic discectomy at an outside facility and harboured residual, incompletely excised and symptomatic herniated thoracic discs. In 12 patients (57%), the initial symptoms that led to their primary operation were improved after the first surgery, but recurred after a mean of 2.8 years. In seven patients (33%) they remained stable, and in two cases they were worse. All patients were treated via all dorsal approaches. In all 21 cases, the initial excision was incomplete regarding medullar decompression. All of the discs were removed completely in a single revision procedure. After mean follow-up of 24 months (range 12-57 months), clinical neurological improvement was demonstrated in seven patients, while three patients suffered a worsening and 11 patients remained stable. Conclusion Our data suggest that pure dorsal decompression provides a short relief of the symptoms caused by spinal cord compression. Progressive myelopathy (probably due to mechanical and vascular deficits) and scar formation may cause worsening of symptoms. Graphic abstractThese slides can be retrieved under Electronic Supplementary Material. Key points3. These lesions require a ventral operative approach to obtain adequate visualization of the dura to resect the discs completely.Dützmann S, Rose R, Rosenthal D (2019) Revision surgery in thoracic disc herniation. Eur Spine J; Keywords Thoracic disc disease · Revision surgery · Thoracoscopy · EndoscopyPublisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Affiliations

Spinal navigation applied to the anterior approach for the resection of thoracic disc herniation: patient series

“…Thoracic discectomy has a reported complication rate of 20%-30%, with whatever technique used, [19][20][21] and the patient must be informed about this remarkable risk. Besides neurological impairment, dural fistulas, and incomplete TDH resection, 22 complications of transthoracic procedures include lung-related conditions (such as atelectasis and pleural effusion) and intercostal neuralgia. 1,2,5,[7][8][9]19,21 Moreover, the risk of wrong-level surgery (WLS) has to be taken in consideration, as it is not so infrequent in thoracic spine operations.…”