Spinal Cord Compression Due to Thoracic Disc Herniation: Results of Microsurgical Posterolateral Costotransversectomy

Abstract

Fifteen consecutive patients with thoracic disc herniation treated by posterolateral microsurgical costotransversectomy are described. With appropriate modifications to the standard technique, costotransversectomy was found to be a suitable approach even for calcified central discs, and discs which had eroded intradurally. All patients had evidence of spinal cord compression preoperatively with varying degrees of leg weakness. The results of surgery are discussed. Ten patients who were disabled but ambulant showed marked improvement in symptoms and signs. Of the remaining five, all of whom were severely disabled and nonambulant preoperatively, four demonstrated significant improvement. Most patients mobilised rapidly, 13 being able to walk unaided within 24 hours. One patient developed an intrathoracic meningocoele postoperatively, which resolved after multiple percutaneous aspirations. Otherwise there were no serious pulmonary complications. We believe that costotransversectomy is the approach of choice for central as well as centrolateral and lateral thoracic disc herniations.

Endoscopic thoracic microdiscectomy

“…Although they provided interesting comparisons, these lack validity because surgical and anesthetic procedures as well as postoperative management practices were vastly different for procedures performed in that era. 5,7,8,12,14,18,27,31,32,43,44,48,50,55 For example, in a thoracotomy or costotransversectomy procedure performed today for the treatment of an uncomplicated thoracic lesion, the incision would be smaller and the operating time, postoperative pain medications, and LOS would likely be cut by 50% compared with the same procedure a decade ago. Even today, LOS and operating time vary widely between surgeons and their respective institutions (Table 5).…”

“…[2][3][4][5]10,32,33,38,52,53 Previous literature on thoracic disc surgery was often collected in a retrospective fashion, spanning many years, and data on patients were often pooled, making it difficult to interpret the patient's initial clinical presentation and their neurological outcomes. 5,7,8,12,14,18,27,31,32,42,44,48,50,55 As a result, there is a lack of quantifiable surgical data as well as information on overall neurological outcome after surgical treatment for these difficult-to-reach lesions. The purpose of this investigation was to establish criteria for outcome measurement in thoracic disc surgery.…”

Thoracic disc herniation with affection of the anterior spinothalamic tract: A case report and review of literature

“…[1] Young et al reported that back pain in 27% of patients and the other common symptom in this series was motor weakness. [3] Sensory disturbances, which had not been specified, were noted in 11% of patients. BSS presentation was Letters to Editor observed in 7% of patients.…”

Interbody fusion usе after discectomy in the thoracic spine

“…Пåðåäíèå îòäåëы МПÄ èñïыòыâàюò бîëüшóю íàãðóзêó, ïîэòî-мó îíè â ïåðâóю îчåðåäü ïîðàaeàюòñя ïðè ãðóäíîм îñòåîхîíäðîзå. Â äàëüíåéшåм ïðè фîðмèðîâàíèè зàäíåé ïðîòðóзèè ñîзäàюòñя ïðåäïîñыëêè äëя íåñòàбèëüíîñòè â ïîзâîíîчíî-äâèãàòåëüíîм ñåãмåíòå, à ïîñëå îïåðàòèâíîãî âмåшàòåëüñòâà ñ óäàëåíèåм чàñòè êîñòíых ñòðóêòóð, îбъåм êîòîðых зàâèñèò îò âыбðàííîãî îïåðàòèâíîãî äîñòóïà, ðèñê âîзíèêíîâå-íèя íåñòàбèëüíîñòè óâåëèчèâàåòñя [5,8,12,16]. Эòî îбóñëîâëèâàåò íåîбхîäèмîñòü ñòàбèëèзàöèè ïîзâî-íîчíî-äâèãàòåëüíîãî ñåãмåíòà ïîñëå îïåðàòèâíîãî âмåшàòåëüñòâà íà ãðóäíîм îòäåëå ïîзâîíîчíèêà.…”