Surgical treatment of thoracic disc protrusion

Abstract

The Authors report on nine cases of thoracic disc hernia operated on through Carson's posterolateral approach. Several steps were taken to protect the spinal cord, and to remove completely disc fragments and any calcifications. The importance of the combined use of the operating microscope and the posterolateral approach are emphasized, and the longterm results are evaluated.

Cadaveric Thoracic Disc Herniation: Fine Architecture of the Prolapse and Relationship with the Posterior Longitudinal Ligament

“…The first case of TDP, in the thoracic (T) 12 disc, was described in 1911 by Middleton and Teacher and since then, over 400 cases have been reported [1,2]. TDP presents extremely infrequently, affecting around 1:1,000,000 people and accounts for 0.15 -4.0% of all spinal disc herniations, with lumbar and cervical protrusions being four and eight times as prevalent compared to TDP [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The rarity of TDP is attributed to 1) the comparatively thin discs of the thoracic vertebrae, 2) minimal flexion of the thoracic spine due to the thoracic facets and 3) the ribcage which splints and supports the thoracic spine [4,18].…”

“…Surgical treatment of TDP is difficult: the spinal denticulate ligaments require transection, and the spinal cord frequently needs to be moved aside to access the lesion. Furthermore, adhesions exist between the thoracic disc and the spinal dura and arachnoid therefore, there is a risk of damage to the spinal cord during procedures and subsequent postoperative dysfunction [4,12,13,21]. Laminectomy for TDP is strongly contraindicated, and a lateral surgical approach to the vertebra has been cited as the most optimal in minimising manipulative trauma to the cord and spinal nerves [2-4, 13, 18, 20, 22, 24, 25].…”