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Giant central thoracic disc herniations: surgical outcome in 17 consecutive patients treated by mini-thoracotomy

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Abstract

Purpose

Safe treatment of giant central thoracic disc herniations (cTDHs) remains a surgical challenge due to frequent calcifications, intradural extension and, importantly, the rare exposure of spine surgeons to these lesions. We report our 10-year experience in the management of giant cTDH by mini-thoracotomy and offer a detailed description of the technique.

Methods

17 patients harboring 17 giant cTDH operated on via a mini-thoracotomy at the authors’ institution between 2004 and 2014 were reviewed. All patients presented with myelopathy of varying magnitude. Mean patient age was 47 years. The mean follow-up period was 5.5 years. Median canal compromise of the cTDH was 66 %. cTDH were densely calcified in 7 (41 %), partially calcified in 6 (35 %) and soft in 4 (24 %) patients. Intradural extension of cTDH was noted in six patients (35 %). Benzels’ modified myelopathy score of the Japanese Orthopedic Association was adjusted for the evaluation of thoracic myelopathy (mJOA) to assess functional outcomes.

Results

Successful removal of the offending cTDH was achieved in all patients. The overall mJOA Score improved from 7.9/13 to 11.1/13. Two patients with giant and densely calcified cTDH experienced a transient post-operative neurological decline. There was a statistically significant correlation between size of cTDH and intradural extension.

Conclusion

Patients with myelopathy due to giant cTDH can be safely treated by the mini-thoracotomy approach. Postoperative neurological worsening and severe complications or incisional pain are rare. In contrast to complex posterior or thoracoscopic approaches, the mini-thoracotomy is technically straightforward and thus easy to learn for experienced spine surgeons.

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References

  1. Williams MP, Cherryman GR, Husband JE (1989) Significance of thoracic disc herniation demonstrated by MR imaging. J Comput Assist Tomogr 13:211–214

    Article  CAS  PubMed  Google Scholar 

  2. Simpson JM, Silveri CP, Simeone FA et al (1993) Thoracic disc herniation. Re-evaluation of the posterior approach using a modified costotransversectomy. Spine 18:1872–1877

    Article  CAS  PubMed  Google Scholar 

  3. Stillerman CB, Weiss MH (1992) Management of thoracic disc disease. Clin Neurosurg 38:325–352

    CAS  PubMed  Google Scholar 

  4. Kim KD, Babbitz JD, Mimbs J (2000) Imaging-guided costotransversectomy for thoracic disc herniation. Neurosurg Focus 9:e7

    CAS  PubMed  Google Scholar 

  5. Perot PL, Munro DD (1969) Transthoracic removal of midline thoracic disc protrusions causing spinal cord compression. J Neurosurg 31:452–458. doi:10.3171/jns.1969.31.4.0452

    Article  PubMed  Google Scholar 

  6. Albrand OW, Corkill G (1979) Thoracic disc herniation. Treatment and prognosis. Spine 4:41–46

    Article  CAS  PubMed  Google Scholar 

  7. Carson J, Gumpert J, Jefferson A (1971) Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 34:68–77

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Jho HD (2000) Endoscopic transpedicular thoracic discectomy. Neurosurg Focus 9:e4

    CAS  PubMed  Google Scholar 

  9. Le Roux PD, Haglund MM, Harris AB (1993) Thoracic disc disease: experience with the transpedicular approach in twenty consecutive patients. Neurosurgery 33:58–66

    Article  PubMed  Google Scholar 

  10. Patterson RH, Arbit E (1978) A surgical approach through the pedicle to protruded thoracic discs. J Neurosurg 48:768–772. doi:10.3171/jns.1978.48.5.0768

    Article  PubMed  Google Scholar 

  11. Bransford R, Zhang F, Bellabarba C et al (2010) Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. J Neurosurg Spine 12:221–231. doi:10.3171/2009.9.SPINE09476

    Article  PubMed  Google Scholar 

  12. Stillerman CB, Chen TC, Couldwell WT et al (1998) Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg 88:623–633. doi:10.3171/jns.1998.88.4.0623

    Article  CAS  PubMed  Google Scholar 

  13. Schmidt MH, Larson SJ, Maiman DJ (2004) The lateral extracavitary approach to the thoracic and lumbar spine. Neurosurg Clin N Am 15:437–441. doi:10.1016/j.nec.2004.04.007

    Article  PubMed  Google Scholar 

  14. Bartels RHMA, Peul WC (2007) Mini-thoracotomy or thoracoscopic treatment for medially located thoracic herniated disc? Spine 32:E581–E584. doi:10.1097/BRS.0b013e31814b84e1

    Article  PubMed  Google Scholar 

  15. Bohlman HH, Zdeblick TA (1988) Anterior excision of herniated thoracic discs. J Bone Joint Surg Am 70:1038–1047

    CAS  PubMed  Google Scholar 

  16. Currier BL, Eismont FJ, Green BA (1994) Transthoracic disc excision and fusion for herniated thoracic discs. Spine 19:323–328

    Article  CAS  PubMed  Google Scholar 

  17. Deviren V, Kuelling FA, Poulter G, Pekmezci M (2011) Minimal invasive anterolateral transthoracic transpleural approach: a novel technique for thoracic disc herniation. A review of the literature, description of a new surgical technique and experience with first 12 consecutive patients. J Spinal Disord Tech 24:E40–E48. doi:10.1097/BSD.0b013e318220af6f

    Article  PubMed  Google Scholar 

  18. Fidler MW, Goedhart ZD (1984) Excision of prolapse of thoracic intervertebral disc. A transthoracic technique. J Bone Joint Surg Br 66:518–522

    CAS  PubMed  Google Scholar 

  19. Hott JS, Feiz-Erfan I, Kenny K, Dickman CA (2005) Surgical management of giant herniated thoracic discs: analysis of 20 cases. J Neurosurg Spine 3:191–197. doi:10.3171/spi.2005.3.3.0191

    Article  PubMed  Google Scholar 

  20. Kasliwal MK, Deutsch H (2011) Minimally invasive retropleural approach for central thoracic disc herniation. Minim Invasive Neurosurg 54:167–171. doi:10.1055/s-0031-1284400

    Article  CAS  PubMed  Google Scholar 

  21. Nacar OA, Ulu MO, Pekmezci M, Deviren V (2013) Surgical treatment of thoracic disc disease via minimally invasive lateral transthoracic trans/retropleural approach: analysis of 33 patients. Neurosurg Rev 36:455–465. doi:10.1007/s10143-013-0461-2

    Article  PubMed  Google Scholar 

  22. Otani K, Yoshida M, Fujii E et al (1988) Thoracic disc herniation. Surgical treatment in 23 patients. Spine 13:1262–1267

    Article  CAS  PubMed  Google Scholar 

  23. Uribe JS, Smith WD, Pimenta L et al (2012) Minimally invasive lateral approach for symptomatic thoracic disc herniation: initial multicenter clinical experience. J Neurosurg Spine 16:264–279. doi:10.3171/2011.10.SPINE11291

    Article  PubMed  Google Scholar 

  24. Zhao Y, Wang Y, Xiao S et al (2013) Transthoracic approach for the treatment of calcified giant herniated thoracic discs. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22:2466–2473. doi:10.1007/s00586-013-2775-8

    Article  Google Scholar 

  25. Gille O, Soderlund C, Razafimahandri HJC et al (2006) Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 15:537–542. doi:10.1007/s00586-005-1014-3

    Article  Google Scholar 

  26. Quint U, Bordon G, Preissl I et al (2012) Thoracoscopic treatment for single level symptomatic thoracic disc herniation: a prospective followed cohort study in a group of 167 consecutive cases. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 21:637–645. doi:10.1007/s00586-011-2103-0

    Article  Google Scholar 

  27. Rosenthal D, Dickman CA (1998) Thoracoscopic microsurgical excision of herniated thoracic discs. J Neurosurg 89:224–235. doi:10.3171/jns.1998.89.2.0224

    Article  CAS  PubMed  Google Scholar 

  28. Sundaresan N, Shah J, Feghali JG (1984) A transsternal approach to the upper thoracic vertebrae. Am J Surg 148:473–477

    Article  CAS  PubMed  Google Scholar 

  29. Benzel EC, Lancon J, Kesterson L, Hadden T (1991) Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 4:286–295

    Article  CAS  PubMed  Google Scholar 

  30. Vitzthum H-E, Dalitz K (2007) Analysis of five specific scores for cervical spondylogenic myelopathy. Eur Spine J 16:2096–2103. doi:10.1007/s00586-007-0512-x

    Article  PubMed  PubMed Central  Google Scholar 

  31. Yoshihara H (2014) Surgical treatment for thoracic disc herniation: an update. Spine 39:E406–E412. doi:10.1097/BRS.0000000000000171

    Article  PubMed  Google Scholar 

  32. Snyder LA, Smith ZA, Dahdaleh NS, Fessler RG (2014) Minimally invasive treatment of thoracic disc herniations. Neurosurg Clin N Am 25:271–277. doi:10.1016/j.nec.2013.12.006

    Article  PubMed  Google Scholar 

  33. Russo A, Balamurali G, Nowicki R, Boszczyk BM (2012) Anterior thoracic foraminotomy through mini-thoracotomy for the treatment of giant thoracic disc herniations. Eur Spine J 21:212–220. doi:10.1007/s00586-012-2263-6

    Article  PubMed Central  Google Scholar 

  34. Moran C, Ali Z, McEvoy L, Bolger C (2012) Mini-open retropleural transthoracic approach for the treatment of giant thoracic disc herniation. Spine 37:E1079–E1084. doi:10.1097/BRS.0b013e3182574657

    Article  PubMed  Google Scholar 

  35. Overvliet GM, Beuls EAM, Ter Laak-Poort M, Cornips EMJ (2009) Two brothers with a symptomatic thoracic disc herniation at T11–T12: clinical report. Acta Neurochir (Wien) 151:393–396. doi:10.1007/s00701-009-0244-2

    Article  Google Scholar 

  36. McInerney J, Ball PA (2000) The pathophysiology of thoracic disc disease. Neurosurg Focus 9:e1

    Article  CAS  PubMed  Google Scholar 

  37. Cornips EMJ, Janssen MLF, Beuls EAM (2011) Thoracic disc herniation and acute myelopathy: clinical presentation, neuroimaging findings, surgical considerations, and outcome. J Neurosurg Spine 14:520–528. doi:10.3171/2010.12.SPINE10273

    Article  PubMed  Google Scholar 

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Correspondence to Roland Roelz.

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Roelz, R., Scholz, C., Klingler, JH. et al. Giant central thoracic disc herniations: surgical outcome in 17 consecutive patients treated by mini-thoracotomy. Eur Spine J 25, 1443–1451 (2016). https://doi.org/10.1007/s00586-016-4380-0

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  • DOI: https://doi.org/10.1007/s00586-016-4380-0

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