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European Spine Journal

, Volume 21, Issue 4, pp 637–645 | Cite as

Thoracoscopic treatment for single level symptomatic thoracic disc herniation: a prospective followed cohort study in a group of 167 consecutive cases

  • Ulrich QuintEmail author
  • Gerd Bordon
  • Inge Preissl
  • Christoph Sanner
  • Daniel Rosenthal
Original Article

Abstract

Problem

Thoracic disc disease with radicular pain and myelopathic symptoms can have serious neurological sequelae. The authors present a relevant treatment option.

Methods

Data of patients with single level symptomatic thoracic disc herniation treated with thoracoscopic microdiscectomy were prospectively collected over a period of 10 years. Data collection included the preoperative status and the follow-up status was 6, 12 and 24 months after surgery for every patient.

Results

A total of 167 single level thorascoscopic discectomies without previous surgery on the level of the procedure were included in this study. The average preoperative duration of pain symptoms was 14.3 months, myelopathic symptoms were present for an average of 16.7 months before surgery. After the procedure pain scores measured with visual analog scale (VAS) decreased by 4.4 points and the muscle strength improved by a mean of 4.6 points (American Spinal Injury Association ASIA motor score). After 2 years, 79% of the patients reported a excellent or good outcome for pain and 80% of the patients reported a excellent or good outcome for motor function. The overall complication rate was 15.6%.

Conclusions

Thoracoscopic microdiscectomy for single level symptomatic disc herniation is a highly effective and reliable technique, it can be performed safely with low complication rate.

Keywords

Thoracic disc herniation Thoracoscopic spine surgery Thoracoscopy Thoracic spine Microsurgical endoscopy 

Notes

Conflict of interest

No funds were received in support of this study.

References

  1. 1.
    Abbott KH, Retter RH (1956) Protrusions of thoracic intervertebral disks. Neurology 1:1–10Google Scholar
  2. 2.
    Anand N, Regan JJ (2002) Video-assisted thoracoscopic surgery for thoracic disc disease. Spine 27(8):871–879PubMedCrossRefGoogle Scholar
  3. 3.
    Arce CA, Dohrmann GJ (1985) Thoracic disc herniation: Improved diagnosis with computed tomographic scanning and a review of the literature. Surg Neurol 23:356–361PubMedCrossRefGoogle Scholar
  4. 4.
    Arseni C, Nash F (1995) Thoracic intervertebral disc protrusion: a clinical study. J Neurosurg 17:418–430Google Scholar
  5. 5.
    Ayhan S, Nelson C et al (2010) Transthoracic surgical treatment for centrally located thoracic disc herniations presenting with myelopathy. A 5-year institutional experience. J Spinal Disord Tech 23(2):79–88PubMedCrossRefGoogle Scholar
  6. 6.
    Balagué F, Fankhauser H (1989) Unusual presentation of thoracic disc herniation. Clin Rheumatol 8(2):269–273PubMedCrossRefGoogle Scholar
  7. 7.
    Broc GG, Crawford NR, Sonntag VK, Dickman CA (1997) Biomechanical effects of transthoracic microdiscectomy. Spine 22(6):605–612PubMedCrossRefGoogle Scholar
  8. 8.
    Carson J, Gumpert J, Jefferson A (1971) Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 34:68–77PubMedCrossRefGoogle Scholar
  9. 9.
    Eichholz KM, O’toole JE, Fessler RG (2006) Thoracic microendoscopic discectomy. Neurosurg Clin N Am 17(4):441–446PubMedCrossRefGoogle Scholar
  10. 10.
    Fessler RG, Sturgill M (1998) Review: complications of surgery for thoracic disc disease. Surg Neurol 49(6):609–618PubMedCrossRefGoogle Scholar
  11. 11.
    Gille O, Soderlund C, Razafimahandri HJ, Mangione P, Vital JM (2006) Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy. Eur Spine J 15(5):537–542PubMedCrossRefGoogle Scholar
  12. 12.
    Horton WC, Kraiwattanapong C et al (2005) The role of the sternum, costosternal articulations, intervertebral discand facets in thoracic sagittal plane biomechanics. A comparison of three different sequences of surgical release. Spine 30(18):2014–2023PubMedCrossRefGoogle Scholar
  13. 13.
    Longo UG, Papapietro N, Maffulli N, Denaro V (2009) Thoracoscopy for minimally invasive thoracic spine surgery. Orthop Clin North Am 40(4):459–464PubMedCrossRefGoogle Scholar
  14. 14.
    Oskouian RJ, Johnson JP (2005) Endoscopic thoracic microdiscectomy. J Neurosurg Spine 3(6):459–464PubMedCrossRefGoogle Scholar
  15. 15.
    Regan JJ, Ben-Yishay A, Mack MJ (1998) Video assisted thoracoscopic excision of herniated thoracic disc: description of technique and preliminary experience in the first 29 cases. J Spinal Disord 11:183–191PubMedCrossRefGoogle Scholar
  16. 16.
    Rosenthal D, Rosenthal R, de Simone A (1994) Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine 19(9):1087–1091PubMedCrossRefGoogle Scholar
  17. 17.
    Rosenthal D, Dickman CA (1998) Thoracoscopic microsurgical excision of herniated thoracic discs. J Neurosurg 89(2):224–235PubMedCrossRefGoogle Scholar
  18. 18.
    Sheikh H, Samartzis D, Perez-Cruet MJ (2007) Techniques for the operative management of thoracic disc herniation: minimally invasive thoracic microdiscectomy. Orthop Clin North Am 38:351–361PubMedCrossRefGoogle Scholar
  19. 19.
    Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH (1998) Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg 88:623–633PubMedCrossRefGoogle Scholar
  20. 20.
    Stillerman CB, Weiss MH (1992) Management of thoracic disc disease. Clin Neurosurg 38:325–352PubMedGoogle Scholar
  21. 21.
    Theodore N, Dickman CA (1996) Current management of thoracic disc herniation. Contemp Neurosurg 18(19):1–7Google Scholar
  22. 22.
    Williams MP, Cherryman GR, Husband JE (1989) Significance of thoracic disc herniation demonstrated by MR imaging. J Comput Tomog 13:211–214CrossRefGoogle Scholar
  23. 23.
    Wood KB, Blair JM, Aepple DM (1997) The natural history of asymptomatic thoracic disc herniations. Spine 22(5):525–530PubMedCrossRefGoogle Scholar
  24. 24.
    Garfin SR, Vaccaro AR (1997) Orthopaedic knowledge update. In: North American Spine Society Spine (ed) Imaging studies of the spine, Rosemont, IL (ISBN 0-89203-169-7)Google Scholar
  25. 25.
    Li AL, Yen D (2011) Effect of increased MRI and CT scan utilization on clinical decision-making in patients referred to a surgical clinic for back pain. Can J Surg 54(2):128–132PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ulrich Quint
    • 1
    Email author
  • Gerd Bordon
    • 2
  • Inge Preissl
    • 2
  • Christoph Sanner
    • 3
  • Daniel Rosenthal
    • 2
  1. 1.Orthopaedic and Trauma Center, Spine Unit, St. Marien-Hospital HammHammGermany
  2. 2.Neurosurgical Section Hochtaunus Kliniken and Neurosurgical AssociatesBad Homburg v.d.HGermany
  3. 3.Radiology DepartmentHochtaunus Kliniken gGmbHBad Homburg v.d.HGermany

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