Risk factors associated with post-operative neurological deterioration in patients with thoracic disc disorders with myelopathy

Lu, Yuan; Chen, Zhongqiang; Li, Weishi; Sun, Chuiguo; Liu, Zhongjun; Liu, Xiaoguang

doi:10.1007/s00264-021-04999-2

Cited by 6 publications

(6 citation statements)

References 24 publications

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“…In previous studies, including 100 patients or more with thoracic disk herniation, postoperative neurological deterioration ranged from 1.2% to 6.2% and was comparable to our results. 3,23,24 Yuan et al 3 indicated that the most significant risk factor was a U-shaped compressed spinal cord. Although no imaging evaluation was performed in this study, IDH patients are likely to have this type of cord compression, and IDH was identified as a risk factor for postoperative neurological deterioration.…”

Section: Discussionmentioning

confidence: 99%

“…First, the preoperative disease duration tends to be prolonged because of its low prevalence and diverse neurological manifestations. [1][2][3] Second, surgery is often required when myelopathy becomes apparent, but complications are more frequent than in the cervical and lumbar spine. [3][4][5][6][7] Third, concomitant cervical and lumbar degenerative stenosis, known as tandem spinal stenosis, may be a cause of misdiagnosis.…”

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confidence: 99%

“…[1][2][3] Second, surgery is often required when myelopathy becomes apparent, but complications are more frequent than in the cervical and lumbar spine. [3][4][5][6][7] Third, concomitant cervical and lumbar degenerative stenosis, known as tandem spinal stenosis, may be a cause of misdiagnosis. 8,9 Among the above clinical issues, a previous study elucidated diverse neurological manifestations in detail.…”

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confidence: 99%

“…Thoracic myelopathy has 3 main features that pose clinical challenges. First, the preoperative disease duration tends to be prolonged because of its low prevalence and diverse neurological manifestations 1–3 . Second, surgery is often required when myelopathy becomes apparent, but complications are more frequent than in the cervical and lumbar spine 3–7 .…”

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confidence: 99%

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Risk Factor Analysis of Surgery-related Complications in Primary Thoracic Spine Surgery for Degenerative Diseases and Characteristics of the Patients Also Undergoing Surgery on the Cervical and/or Lumbar Spine

Takenaka,

Kaito,

Fujimori

et al. 2023

Clinical Spine Surgery

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Study Design: A retrospective cohort study using prospectively collected data. Objective: This study primarily aimed to investigate the risk factors for surgery-related complications in primary thoracic spine surgery for degenerative diseases using a surgeon-maintained database. The secondary purpose was to elucidate the characteristics of surgically treated thoracic myelopathy that also required cervical and/or lumbar spine surgery in the study period. Summary of Background Data: Few studies reported surgical complications and the feature of tandem spinal stenosis in thoracic myelopathy in detail because of their rarity. Materials and Methods: This study included 840 thoracic myelopathy patients undergoing primary surgery for degenerative diseases from 2012 to 2021, investigating the effects of diseases, surgical procedures, and patient demographics on postoperative neurological deterioration, dural tear, dural leakage, surgical-site infection, and postoperative hematoma. In thoracic myelopathy patients who were surgically treated and also undergoing cervical and/or lumbar surgery, we investigated the proportion, the effects of diseases, and the order and intervals between surgeries. Results: Multivariate logistic regression revealed that significant risk factors (P<0.05) for postoperative neurological deterioration were intervertebral disk herniation [odds ratio (OR): 4.59, 95% confidence interval (CI): 1.32–16.0) and degenerative spondylolisthesis (OR: 11.1, 95% CI: 2.15–57.5). Ossification of the ligamentum flavum (OR: 4.12, 95% CI: 1.92–8.86), anterior spinal fusion (OR: 41.2, 95% CI: 4.70–361), and circumferential decompression via a posterior approach (OR: 30.5, 95% CI: 2.27–410) were risk factors for dural tear. In thoracic myelopathy patients surgically treated, 37.0% also underwent degenerative cervical and/or lumbar surgery. Conclusions: Pathologies involving anterior decompression and instability increased the risk of postoperative neurological deterioration. The risk of dural tear was increased when dura mater adhesions were likely to be directly operated upon. It should be recognized that a relatively high proportion (37.0%) of surgically treated thoracic myelopathy patients also underwent cervical and/or lumbar surgery.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Risk Factor Analysis of Surgery-related Complications in Primary Thoracic Spine Surgery for Degenerative Diseases and Characteristics of the Patients Also Undergoing Surgery on the Cervical and/or Lumbar Spine

Takenaka,

Kaito,

Fujimori

et al. 2023

Clinical Spine Surgery

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“…is approach allowed facilitated access to the ventral cord despite being requiring more bony dissection/removal. [1,[7][8][9][10]…”

Section: Intraoperative Iatrogenic and Recurrent Postoperative Dural ...mentioning

confidence: 99%

A challenging recurrent thoracic disc herniation

Capece

Corazzelli²,

Pizzuti

et al. 2023

Surgical Neurology International

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Background: Thoracic disc herniations are rare and occur at the rate of 1/1,000,000/year. Surgical approach must be individually tailored to the size, location, and consistency of the herniated disc. Notably, here, we report the unusual recurrence of a thoracic herniated disc. Case Description: In 2014, a 53-year-old female presented with thoracic back pain, and paraparesis, attributed to an magnetic resonance imaging/computed tomography (CT)-documented left paramedian T8–T9 calcific disc herniation. She underwent a left hemilaminectomy/costotrasversectomy following which she experienced complete regression of her symptoms. Notably, the postoperative radiological studies at that time demonstrated some residual although asymptomatic calcific disc herniation. Eight years later, she again presented, but now with the chief complaint of difficulty breathing. The new CT scan showed a new calcified herniated disc fragment superimposed on the previously documented residual disc. Through a posterolateral transfacet approach, she underwent resection of the disc complex. An intraoperative CT scan confirmed complete removal of the recurrent calcified disc herniation. Following the second surgery, the patient fully recovered and remains asymptomatic. Conclusion: A 53-year-old female first presented with a left-sided T8/T9 thoracic calcified disc herniation that was initially partially resected). When another larger fragment appeared 8 years later, superimposed on the previously documented residual disc, it was successfully removed through a posterolateral transfacet approach completed with CT guidance and neuronavigation.

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Full-endoscopic discectomy for thoracic disc herniations: a single-arm meta-analysis of safety and efficacy outcomes

et al. 2023

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Risk factors associated with post-operative neurological deterioration in patients with thoracic disc disorders with myelopathy

Cited by 6 publications

References 24 publications

Risk Factor Analysis of Surgery-related Complications in Primary Thoracic Spine Surgery for Degenerative Diseases and Characteristics of the Patients Also Undergoing Surgery on the Cervical and/or Lumbar Spine

Risk Factor Analysis of Surgery-related Complications in Primary Thoracic Spine Surgery for Degenerative Diseases and Characteristics of the Patients Also Undergoing Surgery on the Cervical and/or Lumbar Spine

A challenging recurrent thoracic disc herniation

Full-endoscopic discectomy for thoracic disc herniations: a single-arm meta-analysis of safety and efficacy outcomes

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