Two-Level Thoracic Disc Herniation

Boriani, Stefano; Biagini, R.; lure, F. De; Rocella, P.; Veronesi, Vanni; Dalbuono, S; Fiore, Michele

doi:10.1097/00007632-199411000-00018

Cited by 32 publications

(21 citation statements)

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“…Distribution according to gender showed a marked female predominance in the present series consistent with the literature [4,6,7,9,14,17,19,28,30], perhaps due to changes in the hormonal status during menopause and its consequences on calcium-phosphorus metabolism. In the present series, all of the lesions were observed in the lower half of the thoracic spine with a peak of frequency between the eighth and twelfth thoracic vertebrae.…”

Section: Discussionsupporting

confidence: 91%

“…Symptomatic HTHD is more frequent during the fourth and fifth decade of life [4,6,7,14,17,22,26,30], in the framework of a spinal degenerative process. Distribution according to gender showed a marked female predominance in the present series consistent with the literature [4,6,7,9,14,17,19,28,30], perhaps due to changes in the hormonal status during menopause and its consequences on calcium-phosphorus metabolism.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2006

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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

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

et al. 2006

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“…In all approaches, instrumented fusion was considered at the index operation based on the amount of bony removal needed for the discectomy. The thoracotomy, 7,9,10,18,28,34,39 thoracoscopy, 2,24,27,45 and posterolateral 4,8,11,29,40 approaches have been previously described in full detail. In addition, the management strategy for transdural HTDs has been previously described.…”

Section: Surgical Indications and Approachesmentioning

confidence: 99%

“…4,8,15 Anterolateral approaches, consisting of thoracotomy or thoracoscopy, best address large, midline, calcified disc herniations. 10,16,28,34,35,39,45 We report our experience on the management of patients with multiple-level symptomatic HTDs, treated via thoracotomy, thoracoscopy, and/or posterolateral approaches. Patient characteristics, surgical variables, and outcomes are compared among the different approaches and also to those of an unmatched cohort of patients undergoing single-level HTD decompression.…”

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confidence: 99%

Surgical management and clinical outcomes of multiple-level symptomatic herniated thoracic discs

Oppenlander¹,

Clark²,

Kalyvas³

et al. 2013

SPI

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Object Symptomatic herniated thoracic discs (HTDs) are rare, and patients infrequently require treatment of 2 or more disc levels. The authors assess the surgical management and outcomes of patients with multiple-level symptomatic HTDs. Methods A retrospective review of a prospectively maintained database was performed of 220 consecutive patients treated surgically for symptomatic HTDs. Clinical and surgical results were compared between patients with single-level disease and patients with multiple-level disease and also among the different approaches used for surgical decompression. Results Between 1992 and 2012, 56 patients (mean age 48 years; 26 male, 30 female) underwent 62 procedures for 130 HTDs. Forty-six patients (82%) had myelopathy, and 36 (64%) had thoracic radiculopathy; 24 patients had both conditions in varying degree. Symptom duration averaged 28 months. The surgical approach was dictated by disc size, consistency, and location. Twenty-three thoracotomy, 26 thoracoscopy, and 13 posterolateral procedures were performed. Five patients required a combination of approaches. Patients underwent 2-level (n = 44), 3-level (n = 7), 4-level (n = 4), or 5-level (n = 1) discectomies. Instrumented fusion was performed in 36 patients (64%). Thirteen patients harbored 19 additional discs, which were deemed asymptomatic/nonoperative. The mean hospital stay was 6.5 days. Complete disc resection was verified with postoperative imaging in every patient. The procedural complication rate was 23%, and the nature of complications differed based on approach. No patients had surgery-related spinal cord injury or new myelopathy. At a mean follow-up of 48 months, myelopathy and radiculopathy had resolved or improved at a rate of 85% and 92%, respectively. Using a general linear model, preoperative symptom duration (p = 0.037) and perioperative hospital length of stay (p = 0.004) emerged as negative predictors of myelopathy improvement. Most patients (96%) were satisfied with the surgical results. Compared with 164 patients who underwent single-level HTD decompression, patients requiring surgery for multiple-level HTDs were more often myelopathic (p = 0.012). Surgery for multiple-level HTDs was more likely to require a thoracotomy approach (p = 0.00055) and instrumented fusion (p < 0.0001) and resulted in greater blood loss (p = 0.0036) and higher complication rates (p = 0.0069). The rates of resolution for myelopathy (p = 0.24) and radiculopathy (p = 1.0), however, were similar between the 2 patient groups. Conclusions The management of multiple-level symptomatic HTDs is complex, requiring individualized clinical decision making. The surgical approaches must be selected to minimize manipulation of the compressed thoracic spinal cord, and a patient may require a combination of approaches. Excellent surgical results can be achieved in this unique and challenging patient population.

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“…Approximately 75% of all thoracic disc herniations are seen below T8. [1][2][3] The most affected area in the thoracic region is the T11-12 level. 4,5 The first T1-2 disc herniation case was reported in 1954 by Sivien and Karavitis.…”

Section: Introductionmentioning

confidence: 99%