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Sofoluke N, Leyendecker J, Barber S, Reardon T, Bieler E, Patel A, Kashlan O, Bredow J, Eysel P, Gardocki RJ, Hasan S, Telfeian AE, Hofstetter CP, Konakondla S. Endoscopic Versus Traditional Thoracic Discectomy: A Multicenter Retrospective Case Series and Meta-Analysis. Neurosurgery 2024:00006123-990000000-01222. [PMID: 38899868 DOI: 10.1227/neu.0000000000003034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Surgical treatment for symptomatic thoracic disc herniations (TDH) involves invasive open surgical approaches with relatively high complication rates and prolonged hospital stays. Although advantages of full endoscopic spine surgery (FESS) are well-established in lumbar disc herniations, data are limited for the endoscopic treatment of TDH despite potential benefits regarding surgical invasiveness. The aim of this study was to provide a comprehensive evaluation of potential benefits of FESS for the treatment of TDH. METHODS PubMed, MEDLINE, EMBASE, and Scopus were systematically searched for the term "thoracic disc herniation" up to March 2023 and study quality appraised with a subsequent meta-analysis. Primary outcomes were perioperative complications, need for instrumentation, and reoperations. Simultaneously, we performed a multicenter retrospective evaluation of outcomes in patients undergoing full endoscopic thoracic discectomy. RESULTS We identified 3190 patients from 108 studies for the traditional thoracic discectomy meta-analysis. Pooled incidence rates of complications were 25% (95% CI 0.22-0.29) for perioperative complications and 7% (95% CI 0.05-0.09) for reoperation. In this cohort, 37% (95% CI 0.26-0.49) of patients underwent instrumentation. The pooled mean for estimated blood loss for traditional approaches was 570 mL (95% CI 477.3-664.1) and 7.0 days (95% CI 5.91-8.14) for length of stay. For FESS, 41 patients from multiple institutions were retrospectively reviewed, perioperative complications were reported in 4 patients (9.7%), 4 (9.7%) required revision surgery, and 6 (14.6%) required instrumentation. Median blood loss was 5 mL (IQR 5-10), and length of stay was 0.43 days (IQR 0-1.23). CONCLUSION The results suggest that full endoscopic thoracic discectomy is a safe and effective treatment option for patients with symptomatic TDH. When compared with open surgical approaches, FESS dramatically diminishes invasiveness, the rate of complications, and need for prolonged hospitalizations. Full endoscopic spine surgery has the capacity to alter the standard of care for TDH treatment toward an elective outpatient surgery.
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Affiliation(s)
- Nelson Sofoluke
- Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, USA
| | - Jannik Leyendecker
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Sean Barber
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, USA
| | - Eliana Bieler
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Akshay Patel
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Osama Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
- University Hospital Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Raymond J Gardocki
- Department of Orthopedic Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Saqib Hasan
- Golden State Orthopedics and Spine, Oakland, California, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Sanjay Konakondla
- Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, USA
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Corazzelli G, Di Noto G, Ciardo A, Colangelo M, Corvino S, Leonetti S, D'Elia A, Ricciardi F, Bocchino A, Paolini S, Esposito V, Innocenzi G. Posterolateral approaches to the thoracic spine for calcific disc herniation: is wider exposure always better? Acta Neurochir (Wien) 2024; 166:267. [PMID: 38877339 DOI: 10.1007/s00701-024-06146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/26/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To compare the costotransversectomy (CTV) and transpedicular (TP) approaches versus the transfacet (TF) approach for the surgical treatment of calcific thoracic spine herniations (cTDH), in terms of surgical and clinical outcomes. BACKGROUND Surgical approaches for cTDH are debated. Anterior approaches are recommended, while posterolateral approaches are preferred for non-calcific, paramedian, and lateral hernias. Currently, there is limited evidence about the superiority of a more invasive surgical approach, such as CTV or TP, over TF, a relatively less invasive approach, in terms of neurological outcome, pain, and surgical complications, for the treatment of cTDH. METHODS A retrospective, observational, monocentric study was conducted on patients who underwent posterolateral thoracic approaches for symptomatic cTDH, between 2010 and 2023, at our institute. Three groups were drafted, based on the surgical approach used: TF, TP, and CTV. All procedures were assisted by intraoperative CT scan, spinal neuronavigation, and intraoperative neuromonitoring. Analyzed factors include duration of surgery, amount of bone removal, intraoperative blood loss, CSF leak, need of instrumentation for iatrogenic instability, degree of disc herniation removal, myelopathy recovery. Afterwards, a statistical analysis was performed to investigate the bony resection of the superior posterior edge of the vertebral soma. The primary outcome was the partial or total herniation removal. RESULTS This study consecutively enrolled 65 patients who underwent posterolateral thoracic surgery for cTDH. The TF approach taking the least, and the CTV the longest time (p < 0.01). No statistical difference was observed between the three mentioned approaches, in terms of intraoperative blood loss, dural leakage, post-resection instrumentation, total herniation removal, or myelopathy recovery. An additional somatic bony resection was successful in achieving total herniation removal (p < 0.01), and the extent of bony resection was directly proportional to the extent of hernia removal (p < 0.01). CONCLUSIONS No statistically significant differences were highlighted between the TP, TF, and CTV regarding the extent of cTDH removal, the postoperative complications, and the neurological improvement. The described somatic bone resection achieved significant total herniation removal and was directly proportional to the preop against postop anteroposterior diameter difference.
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Affiliation(s)
- Giuseppe Corazzelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy.
| | - Giulio Di Noto
- Division of Neurosurgery, Università Degli Studi Di Messina - Policlinico "G. Martino", Messina, Italy
| | - Antonio Ciardo
- Division of Neurosurgery, Department of Human Neuroscience, University of Rome "Sapienza", Rome, Italy
| | - Manuel Colangelo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | - Sergio Corvino
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | | | | | | | - Andrea Bocchino
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | - Sergio Paolini
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, IS, Italy
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Cleri NA, Zhang J, Singh G, Mikell CB, Pendleton C. Thoracic Intervertebral Disc Herniation Associated With Chronic Anabolic Androgenic Steroid Use: A Case Report. Cureus 2024; 16:e62438. [PMID: 39011187 PMCID: PMC11249193 DOI: 10.7759/cureus.62438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/17/2024] Open
Abstract
Anabolic androgenic steroids (AAS) are relatively cheap and accessible medications, commonly used by athletes and bodybuilders for performance enhancement and muscle growth stimulation. AAS usage has been associated with musculoskeletal injuries, such as tendon and ligament ruptures, and numerous other detrimental health effects. Despite these risks, individuals continue to self-administer these drugs in supraphysiologic doses. Here, we present a case of a male bodybuilder with chronic AAS use who developed a spinal thoracic intervertebral disc herniation requiring decompression and fusion. We use this case to highlight a severe potential risk associated with chronic AAS abuse and review the current literature on the biochemical, physical, and physiologic mechanisms linking chronic AAS use, weight-bearing exercise, and the risk of musculoskeletal injuries such as intervertebral disc herniations.
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Affiliation(s)
| | - Jason Zhang
- Neurosurgery, Stony Brook University, Stony Brook, USA
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Haleem S, Adlan A, Azzopardi C, Botchu R. Calcified Thoracic Disc - A descriptive classification with clinical and management implications. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:236-240. [PMID: 38957761 PMCID: PMC11216641 DOI: 10.4103/jcvjs.jcvjs_167_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/01/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction and Objective Thoracic disc calcification is a radiological finding which may be incidental or diagnosed in patients presenting with myelopathy due to spinal cord compression. We performed a study to analyze the imaging patterns of calcified thoracic discs (CTDs). Patients and Methods A retrospective review of the spinal and radiology database of a tertiary referral orthopedic hospital was conducted for the incidence of CTDs between 2007 and 2020. Patients' demographics and radiological findings were recorded. The relationship between disc size, morphology, spinal cord compression, and management was assessed. Results Fifty-one cases of CTDs were identified. The mean size of CTD was 806.2 mm3 (range: 144-2340). The most common level of disc calcification was T9-T10 (24%) in 12 patients. Thoracic disc calcifications in our series commonly involved disc "protrusion" in 67% (34 patients), followed by "mushroom" type in 31% (16 patients) and "extrusion" in 2% (1 patient). 37% (19 patients) had spinal cord compression with 12% (6 patients) undergoing surgical interventions. There was no statistically significant difference in the mean sizes of CTD between the groups with and without spinal cord compression (P = 0.566, independent sample t-test). Patients with "mushroom" type calcification were more likely to have surgical intervention (P = 0.01, Fisher's exact test). Conclusion Thoracic disc calcifications, while common, can still be underdiagnosed till late myelopathic deterioration. Care of the elderly physicians, spinal surgeons, and radiologists need to be aware of them to guide diagnosis and management. Our study demonstrates that disc morphology plays a vital role in myelopathic presentation and therefore determines the need for surgical intervention instead of the absolute size of disc calcification.
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Affiliation(s)
- Shahnawaz Haleem
- Department of Spinal Surgery, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Amirul Adlan
- Department of Spinal Surgery, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Imaging, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Imaging, The Royal Orthopaedic Hospital, Birmingham, UK
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Nakamura R, Takai K. Small Thoracic Disk Herniation without Spinal Stenosis Presenting with Acute Myelopathy: Three Case Reports. NMC Case Rep J 2023; 10:331-335. [PMID: 38125930 PMCID: PMC10731420 DOI: 10.2176/jns-nmc.2023-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/06/2023] [Indexed: 12/23/2023] Open
Abstract
We herein describe three patients with thoracic disk herniation (TDH) that presented with acute myelopathy at the Tokyo Metropolitan Neurological Hospital between 2014 and 2021 (age range, 45-76 years; male/female ratio = 1:2), with a focus on the mechanisms underlying their development. All patients had sudden-onset gait disturbance due to acute nontraumatic paraparesis. The specialties of the doctors at the first hospital were neurology and orthopedic surgery. TDH was overlooked at the first hospital, and the patients were referred to our hospital. The TDH in all cases was of the central type; however, since they were small, no spinal stenosis was observed. The key feature of all three cases is the small anterior deformation of the spinal cord, making a vascular etiology for the symptoms more plausible than a compressive etiology. After a follow-up of several months or years, two out of three patients underwent surgery with the use of the transfacet pedicle-sparing approach due to residual symptoms. Intraoperative ultrasonography showed that the spinal cord was anchored to TDH by the dural attachment of dentate ligaments. The physical relationship between the dentate ligaments and TDH may be associated with the vascular cause of the symptoms of small TDH.
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Affiliation(s)
- Rika Nakamura
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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Epstein NE, Abulnick MA. Perspective: Transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy. Surg Neurol Int 2023; 14:303. [PMID: 37680932 PMCID: PMC10481820 DOI: 10.25259/sni_648_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023] Open
Abstract
Background Anterior transthoracic, posterolateral (i.e., costotransversectomy/lateral extracavitary), and transpedicular approaches are now utilized to address anterior, anterolateral, or lateral thoracic disk herniations (TDH). Notably, laminectomy has not been a viable option for treating TDH for decades due to the much lower rate of acceptable outcomes (i.e., 57% for decompressive laminectomy vs. over 80% for the posterolateral, lateral, and transthoracic procedures), and a higher risk of neurological morbidity/paralysis. Methods Patients with TDH averaged 48-56.3 years of age, and presented with pain (76%), myelopathy (61%-99%), radiculopathy (30%-33%), and/or sphincter loss (16.7%-24%). Those with anterior/anterolateral TDH (30-74%) were usually myelopathic while those with more lateral disease (50-70%) exhibited radiculopathy. Magnetic resonance (MR) studies best defined soft-tissue/disk/cord pathology, CAT scan (CT)/Myelo-CT studies identified attendant discal calcification (i.e. fully calcified 38.9% -65% vs. partial calcification 27.8%), while both exams documented giant TDH filling > 30 to 40% of the canal (i.e., in 43% to 77% of cases). Results Surgical options for anterior/anterolateral TDH largely included transthoracic or posterolateral approaches (i.e. costotransversectomy, lateral extracavitary procedures) with the occasional use of transfacet/transpedicular procedures mostly applied to lateral disks. Notably, patients undergoing transthoracic, lateral extracavitary/costotransversectomy/ transpedicular approaches may additionally warrant fusions. Good/excellent outcomes were quoted in from 45.5% to 87% of different series, with early postoperative adverse events reported in from 14 to 14.6% of patients. Conclusion Anterior/anterolateral TDH are largely addressed with transthoracic or posterolateral procedures (i.e. costotransversectomy/extracavitary), with a subset also utilizing transfacet/transpedicular approaches typically adopted for lateral TDH. Laminectomy is essentially no longer considered a viable option for treating TDH.
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Affiliation(s)
- Nancy E Epstein
- Clinical Professor of Neurosurgery, School of Medicine, State University of NY at Stony Brook, and Editor-in-Chief Surgical Neurology International NY and c/o Dr. Marc Agulnick 1122 Franklin Avenue Suite 106, Garden City, NY 11530, United States
| | - Marc A Abulnick
- Department of Orthopedics, Assistant Clinical Professor of Orthopedics, NYU Langone Hospital, Long Island, Garden City, New York, 1122 Franklin Avenue Suite 106 Garden City, NY 11530, United States
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Komp M, Ruetten S. Full-endoscopic anterior excision of thoracic disc herniations, including giant and calcified discs with spinal cord compression: surgical technique and outcomes. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2685-2693. [PMID: 37300583 DOI: 10.1007/s00586-023-07807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Operations on thoracic herniated discs are comparatively rare and often demanding. An individual approach and mastery of different surgical techniques and surgical approaches are necessary. The main factors for the chosen surgical technique and approach are the anatomical localization, consistency of the pathology, the general condition of the patient and the experience of the surgeon. The purpose of this study was to evaluate the technical possibilities and outcomes of the full-endoscopic technique with interlaminar, extraforaminal and transthoracic retropleural approaches in patients with symptomatic herniated discs with anterior neural compression. METHODS In 49 patients with thoracic disc herniations, decompression was performed between 2016 and 2020, using a full-endoscopic interlaminar, extraforaminal or transthoracic retropleural approach. Clinical data and imaging were collected during follow-up of 18 months. RESULTS Sufficient decompression was achieved in all cases with the full-endoscopic surgical technique. Two patients experienced worsening of myelopathy, one of which was of transient duration, and one patient required reoperation for an epidural hematoma. No other complications were recorded. All other patients experienced a regression or improvement of symptoms. CONCLUSION The full-endoscopic technique with interlaminar, extraforaminal or transthoracic retropleural approach is a sufficient and minimally invasive method. All three full-endoscopic approaches of the thoracic spine are required to enable sufficient decompression of the anterior pathologies examined here.
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Affiliation(s)
- Martin Komp
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospitals Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Hospitalstrasse 19, 44649, Herne, Germany.
| | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospitals Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Hospitalstrasse 19, 44649, Herne, Germany
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Hamid S, Moradi F, Bagheri SR, Zarpoosh M, Amirian P, Ghasemi H, Alimohammadi E. Evaluation of clinical outcomes, complication rate, feasibility, and applicability of transfacet pedicle-sparing approach in thoracic disc herniation: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:516. [PMID: 37475044 PMCID: PMC10360238 DOI: 10.1186/s13018-023-04016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the clinical outcomes, complication rate, feasibility, and applicability of transfacet pedicle-sparing approach for treating thoracic disc herniation. METHODS We searched three databases including the Cochrane Library, PubMed, and Embase for eligible studies until Dec 2022. The quality of studies and their risk of bias were assessed using the methodological index for non-randomized studies. We evaluated the heterogeneity between studies using the I2 statistic and the P-value for the heterogeneity. RESULTS A total of 328 patients described in 11 included articles were published from 2009 to 2022. Pain outcomes using the visual analog scale (VAS score) were reported in four studies. The standardized mean difference was reported as 0.749 (CI 95% 0.555-0.943). The obtained result showed the positive effect of the procedure and the improvement of patients' pain after the surgery. Myelopathy outcomes using the Nurick score were reported in five studies. The standardized mean difference was reported as 0.775 (CI 95% 0.479-1.071). The result showed the positive effect of the procedure. Eight studies assessed postoperative complications and neurological deterioration. The pooled overall complication was 12.4% (32/258) and 3.5% (9/258) neurological worsening. CONCLUSION The results of this study demonstrated a positive effect of the transfacet pedicle-sparing approach on the clinical outcomes of patients with thoracic disc herniation surgery. The technique has been shown to be safe and effective for the right patient. The technique is associated with lower rates of complications and a shorter hospital stay compared to other surgical approaches. This information can assist clinicians in making informed decisions when selecting the most appropriate surgical technique for their patients with thoracic disc herniation.
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Affiliation(s)
- Shafi Hamid
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Farid Moradi
- Department of Neurosurgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Department of Neurosurgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahsa Zarpoosh
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parsa Amirian
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- School of Nursing and Midwifery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ehsan Alimohammadi
- Department of Neurosurgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Chen KT, Kim JS, Huang APH, Lin MHC, Chen CM. Current Indications for Spinal Endoscopic Surgery and Potential for Future Expansion. Neurospine 2023; 20:33-42. [PMID: 37016852 PMCID: PMC10080449 DOI: 10.14245/ns.2346190.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 04/03/2023] Open
Abstract
Endoscopic spine surgery (ESS) has evolved as a safe, effective, and efficient alternative for minimally invasive spine surgery (MISS). The innovation of full-endoscopic systems makes definitive decompression surgery through different approaches feasible. The approach can be determined according to the location of the target lesion or the surgeon's preference. During the past 2 decades, ESS has expanded its indications from lumbar to cervical spines. Except for decompression, endoscopy-assisted fusion surgery is also developing. However, ESS is still evolving and has a steep learning curve. The revolution of technologies and ESS techniques will enable surgeons to treat various spinal diseases more practically. In recent years, the application of the computer-assisted navigation system and augmented reality have reformed imaging quality and interpretation. The endoscopic rhizotomy techniques have opened a new way for MISS of chronic low back pain. This review introduces the current indications of ESS and its potential future expansion.
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Affiliation(s)
- Kuo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, Chiayi, Taiwan
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Martin Hsiu-Chu Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, Chiayi, Taiwan
| | - Chien-Min Chen
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Corresponding Author Chien-Min Chen Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County 500, Taiwan
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Shen SC, Chen HC, Tsou HK, Lin RH, Shih YT, Huang CW, Tang CL, Chen HT, Chang CC, Tzeng CY. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation based on image analysis and clinical findings: A retrospective review of 345 cases. Medicine (Baltimore) 2023; 102:e32832. [PMID: 36749265 PMCID: PMC9901959 DOI: 10.1097/md.0000000000032832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The effect of spinal anatomical anomalies on the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for disc herniation repair is unclear. This retrospective review aims to assess the safety and effectiveness of PELD for treating L5-S1 disc herniation with a range of characteristics and to determine the prevalence of lumbosacral transitional vertebrae (LSTV) anatomical anomalies to facilitate pre-surgical planning. From July 2005 to June 2019, 345 patients with L5-S1 disc herniations were treated with PELD. The primary outcome was 1-year postoperative visual analogue scale scores for low back and lower limb pain. The secondary outcomes included the surgical approach used, lumbosacral bony anomalies, presence of a ruptured disc or severely calcified disc, pediatric lumbar disc herniation, recurrent disc herniation management, and the long-term outcome. visual analogue scale scores for most patients were significantly improved after surgery. The prevalence of LSTVs was 4.05% (14/345 patients) in lumbar sacralization and 7.53% (26/345 patients) in sacral lumbarization. The prevalence of ruptured and severely calcified discs was 18.55% (64/345) and 5.79% (20/345), respectively. The prevalence of pediatric lumbar disc herniation was 2.02% (7/345). The recurrence rate was 4.34% (15/345). Two durotomy cases without sequelae and 8 cases of lower limb dysesthesia lasting longer than 3 months postoperatively were reported. PELD is safe and effective for treating L5-S1 disc herniation, including cases complicated by calcified lumbar disc herniation, disc rupture with migration, and the presence of LSTV. Appropriate imaging is essential to identify case-specific factors, including the prevalent LSTV anatomical anomalies, before surgery.
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Affiliation(s)
- Shih-Chieh Shen
- Department of Surgery, Tri-Service General Hospital Songshan Branch, National, Defense Medical Center, Taiwan, R.O.C
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taiwan, R.O.C
| | - Hung-Chieh Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, R.O.C
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, R.O.C
- College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, R.O.C
- * Correspondence: Hsi-Kai Tsou, Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung, Taiwan 40705, R.O.C (e-mail: )
| | - Ruei-Hong Lin
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Yu-Tung Shih
- Department of Neurosurgery, Jen-Ai Hospital, Taichung, Taiwan, R.O.C
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, R.O.C
| | - Chih-Wei Huang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Chien-Lun Tang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Hsien-Te Chen
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan, R.O.C
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
- Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Chien-Chun Chang
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
- Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Chung-Yuh Tzeng
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua County, Taiwan, R.O.C
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11
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Marcet P, Wilson J. Minimally Invasive Thoracic Discectomy Instructional Video: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 24:e361-e362. [PMID: 36701587 DOI: 10.1227/ons.0000000000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/08/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Paul Marcet
- Department of Neurosurgery, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
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12
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Intrathecal Cell Therapy with Autologous Bone Marrow Stromal Cells as a New Tool for Neurologic Sequels after Spinal Cord Surgery: A Report of Two Cases. REPORTS 2022. [DOI: 10.3390/reports5040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background aims: The possibility of permanent neurological sequels after surgery of benign lesions affecting the spinal cord is well known. Frequently, they are irreversible, with no effective treatment other than rehabilitation. However, in recent years, intrathecal cell therapy with autologous bone marrow stromal cells (MSCs) in patients with incomplete paraplegia has shown benefits for diverse sequels of spinal cord injury (SCI). Methods: We present two patients with chronic spinal cord sequels after a surgery, who underwent cell therapy treatment with NC1 medicament (repeated intrathecal administrations of MSCs). Results: In both cases, cell therapy achieved a clear improvement in neurological sequels, such as recovery of gait disturbances, bowel dysfunction, or neuropathic pain. Conclusion: Intrathecal cell therapy with autologous MSCs offers a new approach for neurological sequels after spinal cord surgery.
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Kilmister EJ, Guy N, Wickremesekera A, Koeck H. Image-guided transthoracic transpedicular microdiscectomy for a giant thoracic disc herniation: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE2297. [PMID: 36593678 PMCID: PMC9514284 DOI: 10.3171/case2297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/08/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND This case series reports on five consecutive patients who underwent image-guided transpedicular transthoracic microdiscectomy. The authors retrospectively reviewed five patients who had undergone Stealth image-guided transpedicular transthoracic microdiscectomy between 2015 and 2021. OBSERVATIONS Image guidance with O-arm verified critical anatomical landmarks in the setting of large central calcified and/or soft tissue disc prolapse. This allowed limited rib head resection, pedicle removal, and corpectomy to give adequate access and not require interbody fusion. The authors performed a partial posterior corpectomy anterior to the affected disc prolapse and microsurgical delivery of the affected disc anteriorly into the corpectomy cave away from the thecal sac. Electronic and radiographic records were analyzed at their initial presentation and at follow-up. The median patient age was 51 years (range, 44-56 years), with 80% of the patients being males. Four of five patients had significant improvement of their presenting clinical symptoms. One patient had a complicated postoperative recovery with a pneumothorax and subsequent bilateral pneumonia requiring intensive care. Another patient developed delayed postoperative worsening of paraparesis. LESSONS The use of Stealth image guidance with O-arm for transthoracic microdiscectomy for complex calcified thoracic disc herniation is an effective operative technical adjunct to verify anatomical landmarks and limit the microsurgical procedure.
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Creighton A, Cheng J, Press J. Upper Body Injuries in Golfers. Curr Rev Musculoskelet Med 2022; 15:483-499. [PMID: 35930185 PMCID: PMC9789227 DOI: 10.1007/s12178-022-09787-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Golf is a sport that can be played by an athlete of any age, which enhances its popularity. Each golfer's swing is unique, and there is no "right" way to swing the golf club; however, the professional golfer often has more of a consistent swing as opposed to an amateur golfer. A collaborative, team approach involving the golfer with a swing coach, physical therapist, and physician often can be informative on how to prevent golf injury, but also how to treat golf injury if it occurs. RECENT FINDINGS As a rotational sport, the golfer needs to be trained and treated with respect for how the body works as a linkage system or kinetic chain. A warm-up is recommended for every golfer before practicing or playing, and this warm-up should account for every segment of the linkage system. Though it has been thought of as a relatively safe sport, injuries can be seen with golfers of any age or skill level, and upper body injuries involving the cervical and thoracic spine, shoulder, elbow, and wrist are common. A narrative review is provided here of the epidemiology of golf injury and common injuries involving each of these upper body regions. In addition, treatment and injury prevention recommendations are discussed.
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Affiliation(s)
- Andrew Creighton
- Department of Physiatry, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Joel Press
- Department of Physiatry, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
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15
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Surgical management of giant calcified thoracic disc herniation and the role of neuromonitoring. The outcome of large mono centric series. J Clin Neurosci 2022; 100:37-45. [PMID: 35390556 DOI: 10.1016/j.jocn.2022.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/21/2022]
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16
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Safi SS, Allyan A, Ali A, Raza A. Diagnosis and management of thoracic intradural extra-arachnoidal disc herniation. Surg Neurol Int 2022; 13:73. [PMID: 35242439 PMCID: PMC8888305 DOI: 10.25259/sni_16_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Intradural extra-arachnoidal disc herniations (IEDHs) are rare. Here, we reviewed the clinical features and magnetic resonance (MR) diagnostic features of IEDH.
Case Description:
A 58-year-old male presented with mid-thoracic back pain radiating to the left leg associated with ipsilateral leg weakness. The thoracic MR documented T8-T9 focal spinal canal stenosis and a ventral disc herniation. Thoracic spine computed tomography scan confirmed the diseased level and did not show any calcification. The patient underwent a right-sided transpedicular extracavitary approach for disc excision. At surgery, IEDH was identified with soft cartilaginous consistency and was morcellated to remove in piece meal while preserving the integrity of the arachnoid layer.
Conclusion:
IEDH poses a significant challenge for its diagnosis and management. A careful preoperative MR imaging review with a high index of clinical suspicion may ensure a good clinical outcome.
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Affiliation(s)
- Saleh Salah Safi
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar,
| | - Abdulla Allyan
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar,
| | - Arshad Ali
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar,
- Department of Neurological Sciences, Weill Cornell Medicine, Doha, Qatar,
- Department of Clinical Academic Sciences, College of Medicine, Qatar University, Doha, Qatar
| | - Ali Raza
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar,
- Department of Neurological Sciences, Weill Cornell Medicine, Doha, Qatar,
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17
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Cornips EMJ, Beuls EAM. Thoracoscopic Microdiscectomy with Preservation of Rib and Costovertebral Joint. Adv Tech Stand Neurosurg 2022; 45:359-378. [PMID: 35976457 DOI: 10.1007/978-3-030-99166-1_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Thoracic disc herniations (TDH) may cause major morbidity. While thoracoscopic microdiscectomy (TMD) is an excellent technique, postoperative band-like pain is an important drawback. MATERIAL AND METHODS We performed 181 consecutive TMDs (including 39 high-risk cases) with preservation of rib and costovertebral joint (CVJ). We shave a few mm of the rib, drill straight to target, and avoid opening the canal before the TDH is completely free and (in case of giant TDHs) internally debulked, creating initial decompression and limiting epidural venous oozing. Subsequently, we gently mobilize and remove the residual TDH while avoiding leverage. RESULTS Skin-to-skin time was <90' in 64, 90-120' in 48, >120' in 20, unknown in 10, and 162' mean in 39 high-risk procedures. Blood loss was <100 mL in 76, <250 mL in 48, and 537 mL mean in 39 high-risk procedures. The technique was successfully applied in all (including nine dural repairs) without a single conversion. We observed an increased neurological deficit in two (1.1%) and inadequate decompression in merely one (wrong level). Complications (mainly pulmonary) were few and managed conservatively, except for a segmental artery pseudoaneurysm treated endovascularly. We observed a substantial decrease in acute and chronic postoperative pain. DISCUSSION The technique is fast, straightforward, minimizes bone resection and blood loss, improves orientation, safely and effectively deals with any TDH, and prevents postoperative band-like pain as the CVJ is preserved. CONCLUSION We hope this technique will find broader acceptance among a new generation of spine surgeons to benefit patients suffering TDH-related myelopathy or merely intractable pain.
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Affiliation(s)
- E M J Cornips
- Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
| | - E A M Beuls
- Centrum voor Gerechtelijke Geneeskunde, Antwerp University, Antwerp, Belgium
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18
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Posterior-only approach for the treatment of symptomatic central thoracic disc herniation regardless of calcification: A consecutive case series of 30 cases over five years. Clin Neurol Neurosurg 2021; 212:107062. [PMID: 34861470 DOI: 10.1016/j.clineuro.2021.107062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To report the safety and efficacy of posterolateral approach for thoracic disc herniation (TDH) via a consecutive clinical case series of 30 central thoracic disc herniations that were all operated through a posterolateral approach. METHODS A retrospective review was conducted of all patients with symptomatic TDH who underwent surgical intervention from 2016 to 2021. A total of 23 patients comprising 30 central TDH were included in the study. Age, gender, location of the lesion, preoperative and post-operative Frankel and Nurick scores, surgical approach and instrumented vertebrae, and length of stay were recorded. FINDINGS 23 patients with an average age of 62 were included in the study. 30 of the 32 symptomatic TDH were centrally located. 8/32 TDH were calcified while 24/32 TDH were non-calcified. Unilateral and bilateral transpedicular approach was used in the treatment of 12/32 and 10/32 disc herniations respectively. A transfacet-pedicle sparing approach was used in 10/32 disc herniations. 19/23 (82.6%) of the patients had improvement in Nurick score while 12/23 (52.2%) patients had improvement in their Frankel scores. The average length of stay was 4.5 days. No major complications were encountered. All patients underwent a short-segment instrumented construct with no need for revision surgery for thoracic disc herniation, worsening myelopathy, or instrumentation failure. CONCLUSIONS 83% of the patients who underwent a transfacet or transpedicular decompression for the treatment of symptomatic TDH had improvement in their myelopathy with no neurological deterioration in any of the patients. Given the familiarity and low morbidity associated with a transfacet or transpedicular approach, posterolateral-based approaches remains an excellent alternative for surgical management of majority of the patients with thoracic disc herniations.
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19
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Kashyap S, Webb AG, Friis EA, Arnold PM. Management of single-level thoracic disc herniation through a modified transfacet approach: A review of 86 patients. Surg Neurol Int 2021; 12:338. [PMID: 34345479 PMCID: PMC8326068 DOI: 10.25259/sni_94_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Symptomatic thoracic disc herniation (TDH) is rare and does not typically resolve with conservative management. Traditional surgical management is the transthoracic approach; however, this approach can carry significant risk. Posterolateral approaches are less invasive, but no single approach has proven to be more effective than the other results are often dependent on surgeon experience with a particular approach, as well as the location and characteristics of the disc herniation. Methods: This was retrospective review of a prospectively collected database. Eighty-six patients with TDH treated surgically through the modified transfacet approach were reviewed and evaluated for pain improvement, Nurick grade, and neurological symptoms. Patients were followed for 12 months postoperatively; estimated blood loss, length of hospital stay, hospital course, and postoperative complications were also assessed. Results: All attempts at disc resection were successful. Most patients reported improvement in pain, sensory involvement, and strength. Seventy-nine patients had complete resolution of their symptoms while four patients had unchanged symptoms. Three patients experienced mild neurologic worsening postoperatively, but this resolved back to baseline. One patient experienced myelopathy during the postoperative period that resolved with steroid administration. The procedure was well tolerated with minimal complications. Conclusion: TDH can be managed surgically through a variety of approaches. The selection of approach is dependent on surgeon experience with an approach, the patient’s health, and the location and type of disc. The transfacet approach is safe and efficacious.
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Affiliation(s)
- Samir Kashyap
- Department of Neurosurgery, Riverside University Health System, Riverside, California, United States
| | - Andrew G Webb
- Department of Clinical Imaging Research, Carle Illinois College of Medicine Beckman Institute of Advanced Science and Technology, Urbana, Illinois, United States
| | - Elizabeth A Friis
- Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas
| | - Paul M Arnold
- Department of Neurosurgery, Carle Neuroscience Institute, Urbana, Illinois, United States
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20
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Assessment of thoracic disk herniation by using virtual noncalcium dual-energy CT in comparison with standard grayscale CT. Eur Radiol 2021; 31:9221-9231. [PMID: 34076743 PMCID: PMC8589804 DOI: 10.1007/s00330-021-07989-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/04/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
Objectives To determine the diagnostic accuracy of dual-energy CT (DECT) virtual noncalcium (VNCa) reconstructions for assessing thoracic disk herniation compared to standard grayscale CT. Methods In this retrospective study, 87 patients (1131 intervertebral disks; mean age, 66 years; 47 women) who underwent third-generation dual-source DECT and 3.0-T MRI within 3 weeks between November 2016 and April 2020 were included. Five blinded radiologists analyzed standard DECT and color-coded VNCa images after a time interval of 8 weeks for the presence and degree of thoracic disk herniation and spinal nerve root impingement. Consensus reading of independently evaluated MRI series served as the reference standard, assessed by two separate experienced readers. Additionally, image ratings were carried out by using 5-point Likert scales. Results MRI revealed a total of 133 herniated thoracic disks. Color-coded VNCa images yielded higher overall sensitivity (624/665 [94%; 95% CI, 0.89–0.96] vs 485/665 [73%; 95% CI, 0.67–0.80]), specificity (4775/4990 [96%; 95% CI, 0.90–0.98] vs 4066/4990 [82%; 95% CI, 0.79–0.84]), and accuracy (5399/5655 [96%; 95% CI, 0.93–0.98] vs 4551/5655 [81%; 95% CI, 0.74–0.86]) for the assessment of thoracic disk herniation compared to standard CT (all p < .001). Interrater agreement was excellent for VNCa and fair for standard CT (ϰ = 0.82 vs 0.37; p < .001). In addition, VNCa imaging achieved higher scores regarding diagnostic confidence, image quality, and noise compared to standard CT (all p < .001). Conclusions Color-coded VNCa imaging yielded substantially higher diagnostic accuracy and confidence for assessing thoracic disk herniation compared to standard CT. Key Points • Color-coded VNCa reconstructions derived from third-generation dual-source dual-energy CT yielded significantly higher diagnostic accuracy for the assessment of thoracic disk herniation and spinal nerve root impingement compared to standard grayscale CT. • VNCa imaging provided higher diagnostic confidence and image quality at lower noise levels compared to standard grayscale CT. • Color-coded VNCa images may potentially serve as a viable imaging alternative to MRI under circumstances where MRI is unavailable or contraindicated.
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21
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Ishizuka K, Yokokawa D, Ikusaka M. Thoracic disk herniation diagnosed with an upper body traction procedure in the sitting position. J Gen Fam Med 2021; 22:148-149. [PMID: 33977011 PMCID: PMC8090847 DOI: 10.1002/jgf2.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/19/2020] [Accepted: 11/04/2020] [Indexed: 11/09/2022] Open
Abstract
A 51-year-old man experienced sudden abdominal pain from the umbilicus to the right flank 5 days before his hospital visit. His abdominal pain disappeared when the examiner lifted his upper body in the sitting position. MRI revealed posterior intervertebral disc protrusion in the right paramedian region at the 9th/10th thoracic vertebrae. With the treatment, it is reported that traction is the appropriate initial approach for spine radiculopathy. Improvement with upper body traction performed in this case, which is a previously unreported maneuver, appears to be useful for diagnosis because it eliminates the influence of gravity and reduces intradiscal pressure.
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Affiliation(s)
- Kosuke Ishizuka
- Department of General Medicine Chiba University Hospital Chiba Japan
| | - Daiki Yokokawa
- Department of General Medicine Chiba University Hospital Chiba Japan
| | - Masatomi Ikusaka
- Department of General Medicine Chiba University Hospital Chiba Japan
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22
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Wessell A, Mushlin H, Fleming C, Lewis E, Sansur C. Thoracic Discectomy Through a Unilateral Transpedicular or Costotransversectomy Approach With Intraoperative Ultrasound Guidance. Oper Neurosurg (Hagerstown) 2020; 17:332-337. [PMID: 30476309 DOI: 10.1093/ons/opy348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 10/04/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The disc location, extent of calcification, limited visualization of the ventral cord, and tenuous blood supply to the thoracic spinal cord pose unique technical challenges when surgically treating thoracic disc herniation. OBJECTIVE To report our initial experience with a series of cases in which intraoperative ultrasound image guidance was used for thoracic discectomy through a unilateral transpedicular or costotransversectomy approach. METHODS Five patients (n = 5) underwent a transpedicular approach and five (n = 5) underwent costotransversectomy for thoracic discectomy. Pre- and postoperative clinical records, operative reports, disc location/calcification, and complications were reviewed. RESULTS There were 6 (n = 6) males and 4 (n = 4) females with an average age of 54 yr (range: 33-74). All patients had symptoms attributable to a single-level of thoracic disc herniation. Discs were classified as central (n = 5) and paracentral (n = 5). Preoperative CT and/or intraoperative visualization demonstrated calcified disc material in 6 (n = 6) patients. Final outcomes data at last follow-up was available for 9 of 10 patients. Eight of these nine patients experienced a return to normal baseline functional status. Postoperative imaging confirmed that no wrong-level surgeries were performed. The mean length of follow-up was 20.4 wk (range 4-48). CONCLUSION Thoracic discectomy with ultrasound visualization via a unilateral transpedicular or costotransversectomy approach is safe and effective for treatment of central and paracentral calcified disc herniations. This tool improves the safety profile of thoracic discectomy and allows for treatment of thoracic discs through less invasive approaches.
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Affiliation(s)
- Aaron Wessell
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland
| | - Harry Mushlin
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland
| | - Charles Fleming
- School of Medicine, University of Maryland, Baltimore, Maryland
| | - Evan Lewis
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland
| | - Charles Sansur
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland
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23
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Ishii M, Nishimura Y, Hara M, Eguchi K, Nagashima Y, Awaya T, Ando R, Haimoto S, Wakabayashi T. Thoracic Disc Herniation Manifesting as Abdominal Pain Alone Associated with Thoracic Radiculopathy. NMC Case Rep J 2020; 7:161-165. [PMID: 33062562 PMCID: PMC7538457 DOI: 10.2176/nmccrj.cr.2019-0247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/03/2020] [Indexed: 11/20/2022] Open
Abstract
Symptomatic thoracic disc herniation (TDH) with thoracic radiculopathy alone is an extremely rare condition. Here, we report a rare case of TDH in a 52-year-old man who presented with medically refractory severe right flank pain. Based on pain distribution, pain intensity changes according to truncal position, ineffectiveness of intercostal nerve block, and radiological findings, his pain was determined to be caused by TDH at T9-10 level. Symptomatic TDH often requires invasive surgery. However, TDH with radiculopathy alone can be treated via a posterior approach without spinal cord manipulation or spinal fusion. We could eliminate the pain by removing TDH with hemilaminectomy and microdiscectomy using an O-arm-based navigation system.
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Affiliation(s)
- Motonori Ishii
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan
| | - Masahito Hara
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Kaoru Eguchi
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan
| | - Yoshitaka Nagashima
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan
| | - Takayuki Awaya
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan
| | - Ryo Ando
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan
| | - Shoichi Haimoto
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan
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24
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Krishnan A, Degulmadi D, Mayi S, Kulkarni M, Reddy C, Singh M, Rai RR, Dave BR. Transforaminal Thoracic Interbody Fusion for Thoracic Disc Prolapse: Surgicoradiological Analysis of 18 Cases. Global Spine J 2020; 10:706-714. [PMID: 32707016 PMCID: PMC7383794 DOI: 10.1177/2192568219870459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVES Thoracic disc prolapse (TDP) surgeries have reported complications ranging from paraplegia to approach related complications. This study is to present a series of TDP patients surgically treated with transforaminal thoracic interbody fusion (TTIF). Emphasis on surgical technique and strategies to avoid complications are analyzed. METHODS Eighteen patients with TDP were included. Imagings were analyzed for end-plate changes and calcification. Type of disc prolapse (central/para-central) and percentage of canal occupancy were noted. Objective outcome was quantified with Visual Analogue Scale (VAS), modified Nurick's grade, and ASIA (American Spinal Injury Association) score. All complications were noted. RESULTS Eighteen patients (average age 43.65 years) having total 22 levels operated, that included double level (n = 2) and missed level (n = 2) are reported. All patients had myelopathy. Calcification of disc (n = 13), central disc prolapses (n = 9), para-central (n = 11) and more than 50% canal occupancy (n = 8) were noted. VAS back pain, modified Nurick's grade and ASIA grade improved significantly in all patients. One patient had postoperative transient deficit. The functional score achieved its maximum at 1 year follow-up and remained static at final follow-up of 65.05 months. Union was achieved in all patients. CONCLUSIONS The most important factor for outcome in TDP is the technical aspect of avoiding cord manhandling and avoiding wrong level surgeries. TTIF is not devoid of complications but can give good results to posterior approach trained surgeons.
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Affiliation(s)
- Ajay Krishnan
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
- BIMS Hospital, Bhavnagar, Gujarat, India
- Ajay Krishnan, C302, Orange Avenue, Maple County 1, Thaltej, Ahmedabad, Gujarat 380059, India.
| | | | - Shivanand Mayi
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Mahesh Kulkarni
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Chaitanya Reddy
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Mreetunjay Singh
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Ravi Ranjan Rai
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Bharat R. Dave
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
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25
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Soda C, Faccioli F, Marchesini N, Ricci UM, Brollo M, Annicchiarico L, Benato C, Tomasi I, Pinna GP, Teli M. Trans-thoracic versus retropleural approach for symptomatic thoracic disc herniations: comparative analysis of 94 consecutive cases. Br J Neurosurg 2020; 35:195-202. [PMID: 32558605 DOI: 10.1080/02688697.2020.1779660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The authors illustrate their results in the surgical treatment of symptomatic thoracic disc herniations (TDHs) by comparing the traditional open to the less invasive retropleural lateral approaches. METHODS Retrospective review of 94 consecutive cases treated at a single Institution between 1988 and 2014. Fifty-two patients were males, 42 females, mean age was 53.9 years. Mean follow-up was 46.9 months (12-79 months). 33 patients were diagnosed with a giant thoracic disc herniation (GTDH). Upon admission, the most common symptoms were: motor impairment (91.4%, n = 86), neuropathic radicular pain with VAS > 4 (50%), bladder and bowel dysfunction (57.4% and 41.4% respectively) and sensory disturbances (29.7%). The surgical approach was based upon level, laterality and presence or absence of calcified lesions. RESULTS Decompression was performed in 7 cases via a thoraco-laparo-phrenotomy and in 87 cases via an antero-lateral thoracotomy. Out of the latter cases, 49 (56%) were trans-thoracic trans-pleural approaches (TTA) and 38 (44%) were less invasive retropleural approaches (MIRA). At follow-up, there were 59.5% neurologically intact patients according to the McCormick Scale, while 64.8% and 67% had no bladder or bowel dysfunction respectively. Complications occurred in 24 patients (25.5%). Pulmonary complications were the commonest (12.7%) with pleural effusion being significantly more common in patients treated with TTA compared to MIRA (20% vs 5.2%: X2 4.13 P:0.042). Severe post-operative neuralgia (VAS 7-10) was also significantly more frequent in the TTA group (22.4% vs 2.6% X2 7.07 p 0.0078). CONCLUSIONS MIRA is a safe and effective technique to obtain adequate TDH decompression and is associated with lower morbidity compared to TTA.
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Affiliation(s)
- Christian Soda
- Department of Neurosurgery, Verona Borgo Trento Hospital, Verona, Italy
| | - Franco Faccioli
- Department of Neurosurgery, Verona Borgo Trento Hospital, Verona, Italy
| | - Nicolò Marchesini
- Department of Neurosurgery, Verona Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Umberto M Ricci
- Department of Neurosurgery, Verona Borgo Trento Hospital, Verona, Italy
| | - Marco Brollo
- Department of Neurosurgery, Mestre Hospital, Mestre, Italy
| | | | - Cristiano Benato
- Department of Thoracic Surgery, Borgo Trento Hospital, Verona, Italy
| | - Ivan Tomasi
- Department of Emergency General Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Marco Teli
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK
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Rahimizadeh A, Zohrevand AH, Kabir NM, Asgari N. T1-T2 disc herniation: Report of four cases and review of the literature. Surg Neurol Int 2019; 10:56. [PMID: 31528394 PMCID: PMC6743685 DOI: 10.25259/sni-34-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/17/2019] [Indexed: 11/06/2022] Open
Abstract
Background: Symptomatic T1–T2 disc herniations are rare and, in most cases, are located posterolaterally. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. Case Description: Here, we reviewed four cases of symptomatic T1–T2 disc herniations; two patients were paraparetic due to central discs and underwent anterior surgery utilizing a cage construct. The latter two cases had posterolateral discs contributing to a Brown-Sequard syndrome and radiculopathy, respectively; one patient required a transfacet pedicle-sparing procedure, while the second case was managed conservatively. All surgically treated patients recovered fully. Conclusions: We reviewed 4 cervical T1–T2 disc herniations; two central/anterolateral lesions warranting anterior surgical approaches/cages, and 2 lateral discs treated with a posterolateral transfacet, pedicle-sparing procedure and no surgery respectively. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc.
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Affiliation(s)
- Abolfazl Rahimizadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Zohrevand
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nima Mohseni Kabir
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Asgari
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
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Balaha AM, Shamhoot EA. Combined Transpedicular-Transarticular Approach for Ventrally Located Thoracic Intradural Meningiomas. Asian J Neurosurg 2019; 14:744-747. [PMID: 31497095 PMCID: PMC6703077 DOI: 10.4103/ajns.ajns_57_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The ventrally located intradural meningiomas in the thoracic spine are still considered a challenge for all spine surgeons. Many surgical approaches were developed to excise the lesion without violating the neural structures. They differ in their invasiveness, safety, and efficacy. One of these approaches is the postero-lateral combined transpedicular-transarticular approach (TPA-TAA). Patients and Methods From January 2016 to December 2018, all patients with ventrally located thoracic meningiomas were operated on using the combined TPA-TAA. We evaluated all the patients preoperatively, immediate postoperative, and 6 months later. Clinical and functional outcomes were assessed using the muscle strength grade and the Nurick grading system. Magnetic resonance imaging was obtained for all patients postoperative and at 6 months later. Results After 6 months, all patients experienced clinical and functional improvement. The mean muscle strength grade rose from 3.8 preoperatively to 4.8 after 6 months. According to the Nurick grading system, the mean preoperative grade was 4.4 and dropped to 1.8 after 6 months. Minor transient complications such as superficial wound infection and the cerebrospinal fluid leak were observed in 1 patient for each. Gross total tumor excision was achieved in all patients. No cases of tumor recurrence were noted during the follow-up period. Conclusions This combined TPA-TAA is considered a safe and effective approach in excising ventrally located intradural thoracic meningiomas with minimal postoperative morbidities.
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Thoracic disc herniation, avoidance, and management of the surgical complications. INTERNATIONAL ORTHOPAEDICS 2019; 43:817-823. [DOI: 10.1007/s00264-018-04282-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/26/2018] [Indexed: 02/06/2023]
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T1-T2 Disk Herniation Presenting With Horner Syndrome: A Case Report With Literary Review. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 2:e016. [PMID: 30656256 PMCID: PMC6324895 DOI: 10.5435/jaaosglobal-d-18-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Horner syndrome or oculosympathetic paresis is caused by interruption of the sympathetic nerve supply to the face and eye that manifests as facial anhidrosis, blepharoptosis, and miosis. This sympathetic pathway begins in the hypothalamus and synapses in the intermediolateral gray substance of the spinal cord at C8-T2 levels making it susceptible to disruption via a high thoracic intervertebral disk herniation. We present a rare case of a patient with T1-T2 intervertebral disk herniation and Horner syndrome who was treated surgically. After confirming the diagnosis with MRI, the patient was treated with standard posterior approach with laminoforaminotomy and diskectomy. Although posterior approach surgery is most commonly used for laminectomy and/or foraminotomy, successful anterior approaches to upper thoracic lesions are valid as well. Our patient had resolution of his back pain, paresthesias, and grip weakness at 6 weeks postoperatively, but his Horner syndrome persisted at latest follow-up. Patients with cervical radiculopathy symptoms and physical examination findings consistent with Horner syndrome should be evaluated with a MRI that includes the upper thoracic spine. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome.
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Oltulu I, Cil H, Ulu MO, Deviren V. Clinical outcomes of symptomatic thoracic disk herniations treated surgically through minimally invasive lateral transthoracic approach. Neurosurg Rev 2019; 42:885-894. [PMID: 30617649 DOI: 10.1007/s10143-018-01064-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 11/03/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
Although symptomatic thoracic disk herniation (TDH) is relatively rare, its treatment is quite difficult. Our aim is to present the outcomes and complications in patients with thoracic disk herniation treated with minimally invasive lateral transthoracic approach (LTTA). Fifty-nine consecutive patients with 69 symptomatic disk herniations that underwent minimally invasive LTTA to treat TDH between 2007 and 2016 were enrolled. Medical records were reviewed retrospectively. The numbers of TDH were as follows: 41 central, 10 paracentral, and 18 both central and paracentral. The number of calcified disk herniations was found to be 32. No patient developed neurological deficit. Postoperative neurological improvement occurred in 39 (90.7%) of 43 patients with myelopathy. Preoperative VAS scores, ODI scores, and SF-36 scores improved at the follow-up, respectively. Mean blood loss, hospitalization period, and follow-up period were found to be 391.2 mL, 4.7 days, and 60 months; respectively. The following complications were observed: dural tear (five patients), intercostal neuralgia (three patients), rib fracture (one patient), pleural effusion requiring chest tube (two patients), hydropneumothorax requiring chest tube (one patient), small pneumothorax (one patient), atelectasis (one patient), pulmonary embolism (one patient), and pneumonia (one patient). Minimally invasive LTTA not only minimizes the manipulation of the thecal sac decreasing the risk for neurological injury compared to traditional posterior methods but also significantly decreases the pulmonary complications associated with traditional open procedures. Based on the authors' experience, anterior approach should be preferred especially in calcified central disk herniations regardless of surgeon's experience.
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Affiliation(s)
- Ismail Oltulu
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Avenue, MU 320W, San Francisco, CA, 94143-0728, USA
| | - Hemra Cil
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Avenue, MU 320W, San Francisco, CA, 94143-0728, USA
| | - Mustafa Onur Ulu
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Avenue, MU 320W, San Francisco, CA, 94143-0728, USA.
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Yüce İ, Kahyaoğlu O, Çavuşoğlu HA, Çavuşoğlu H, Aydın Y. Midterm outcome of thoracic disc herniations that were treated by microdiscectomy with bilateral decompression via unilateral approach. J Clin Neurosci 2018; 58:94-99. [DOI: 10.1016/j.jocn.2018.09.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/07/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
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Andrade P, Cornips EMJ, Sommer C, Daemen MA, Visser-Vandewalle V, Hoogland G. Elevated inflammatory cytokine expression in CSF from patients with symptomatic thoracic disc herniation correlates with increased pain scores. Spine J 2018; 18:2316-2322. [PMID: 30077044 DOI: 10.1016/j.spinee.2018.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/27/2018] [Accepted: 07/27/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND The pathophysiology of pain in patients with symptomatic thoracic disc herniation (TDH) remains poorly understood. Mere mechanical compression of the spinal cord and/or the exiting nerve root by a prolapsed disc cannot explain the pathogenesis of pain in all cases. Previous studies report a direct correlation between the levels of proinflammatory cytokines in disc biopsies and the severity of leg pain in patients with lumbar disc herniation. A similar correlation in patients with TDH has not been investigated. PURPOSE To correlate the cerebrospinal fluid (CSF) expression of cytokines and pain-related amino acids with preoperative pain scores in patients with symptomatic TDH. STUDY DESIGN A prospective human study of CSF samples and clinical outcome scores. METHODS Using enzyme-linked immunosorbent assay (ELISA) and high-performance liquid chromatography (HPLC), we determined inflammatory cytokine levels (TNF-α, IL-1β, and IL-10) and amino acid levels (glutamate, aspartate, gamma-aminobutyric acid, glycine, and arginine) in CSF samples from 10 patients with TDH and 10 control subjects who did not suffer an inflammatory disease nor pain related to spinal cord compression and subsequently correlated these levels with preoperative pain scores. Differences between both groups were evaluated by a Mann-Whitney U test. In order to estimate the correlation between cytokine or amino acid expression and pain scores, data were analyzed using a linear regression analysis. RESULTS No inflammatory cytokines were found in CSF samples from control subjects, whereas TNF-α, IL-1β, and IL-10 were detectable by ELISA in all CSF samples from patients with TDH. TNF-α and IL-10 but not IL-1β levels moderately correlated with preoperative pain scores. Elevated TNF-αlevels positively correlated with high pain scores; elevated IL-10 levels negatively correlated with high pain scores. Amino acids were detectable in all samples from both groups. There were no significant differences between the groups in any of the amino acids measured with HPLC. CONCLUSION Increased proinflammatory cytokine expression is associated with elevated pain scores in patients with symptomatic TDH. On the other hand, there is no conclusive correlation between the intensity of pain and the local or systemic presence of amino acids associated with pain transmission.
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Affiliation(s)
- Pablo Andrade
- Department of General Neurosurgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany; School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, Netherlands.
| | - Erwin M J Cornips
- Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Josef-Schneider-StraÔe 11, 97080, Würzburg, Germany
| | - Marc A Daemen
- Department of Neurosurgery, NedSpine, Pascalstraat 21, 6716 AZ, Ede, Netherlands
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Govert Hoogland
- School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, Netherlands; Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands
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Huang YP, Lin JH, Chen XP, Wu G, Chen XW. Preliminary experience in treating thoracic spinal tuberculosis via a posterior modified transfacet debridement, instrumentation, and interbody fusion. J Orthop Surg Res 2018; 13:292. [PMID: 30458830 PMCID: PMC6245769 DOI: 10.1186/s13018-018-0994-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posterior transfacet approach has been proved to be a safe and effective access to treat thoracic disc herniation. However, the therapeutic effect and safety of modified transfacet approach for treating thoracic spinal tuberculosis (TST) has not been reported in the clinical literature. In this study, the clinical efficacy and safety of a single-stage posterior modified transfacet debridement, posterior instrumentation, and interbody fusion for treating TST were retrospectively evaluated. PATIENTS AND METHODS From 2009 to 2014, 37 patients with TST underwent a posterior modified transfacet debridement, interbody fusion following posterior instrumentation, under the cover of 18 months of antituberculosis chemotherapy. The patients were evaluated preoperatively and postoperatively in terms of Frankel Grade, visual analog scale (VAS) pain score, kyphotic Cobb angle, and bony fusion. RESULTS The follow-up time was 39.8 ± 5.1 months (29-50 months). No postoperative complication or recurrence of spinal tuberculosis was observed. Definitive bony fusion was achieved in all patients. At the final follow-up, 2 cases were rated as Frankel grade D, 35 as grade E. VAS was recovered from 8.4 ± 1.0 cm to 0.4 ± 0.8 cm. The kyphotic angles were corrected from 29.4 ± 10.9° to 17.6 ± 6.3°. Using the Kirkaldy-Willis criteria, functional outcome was excellent in 29 patients, good in 7, and fair in 1. CONCLUSIONS Our preliminary results showed that single-stage posterior modified transfacet debridement, posterior instrumentation, and interbody fusion are effective and safe surgical options for treating TST.
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Affiliation(s)
- Yun-Peng Huang
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou City, 350005, Fujian Province, China
| | - Jian-Hua Lin
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou City, 350005, Fujian Province, China
| | - Xiao-Ping Chen
- School of Mathematics and Informatics, Fujian Normal University, Fuzhou City, 350117, Fujian Province, China
| | - Gui Wu
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou City, 350005, Fujian Province, China
| | - Xuan-Wei Chen
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou City, 350005, Fujian Province, China.
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Bouthors C, Benzakour A, Court C. Surgical treatment of thoracic disc herniation: an overview. INTERNATIONAL ORTHOPAEDICS 2018; 43:807-816. [PMID: 30406842 DOI: 10.1007/s00264-018-4224-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical treatment of thoracic disc herniation (TDH) is technically demanding due to its proximity to the spinal cord. METHODS Literature review. RESULTS Symptomatic TDH is a rare condition predominantly localized between T8 and L1. Surgical indications include intractable back or radicular pain, neurological deficits, and myelopathy signs. Giant calcified TDH (> 40% spinal canal occupation) are frequently associated with myelopathy, intradural extension, and post-operative complications. Careful pre-operative planning helps reduce the risk of complications. Pre-operative CT and MRI identify the hernia's location and size, calcifications, and intradural extension. The approach must provide adequate dural sac visualization with minimal manipulation of the cord. Non-anterior approaches are favoured if they provide at least equal exposure than anterior approach owing to higher risk of pulmonary morbidity associated with anterior approach. A transthoracic approach is recommended for central calcified herniated discs. A posterolateral approach is often suitable for non-calcified lateralized TDH. Thoracoscopic approaches are less invasive but have a substantial learning curve. Retropleural mini-thoracotomy is an acceptable alternative. Pre-operative identification of the pathological level is confirmed by intra-operative level check. Intra-operative cord monitoring is preferable but warrant further studies. Magnification and adequate lightening of the surgical field are paramount (microscope, thoracoscopy). Intra-operative CT scan with navigation is becoming increasingly popular since it provides real-time control on the decompression. Indications of fusion consist of pre-operative back pain, Scheuermann's disease, multilevel resection, wide vertebral body resection (> 50%), and herniation at thoracolumbar junction. Neurological deterioration, dural tear, and subarachnoid-pleural fistula are the most severe complications. CONCLUSION Further improvements are still warranted in thoracic spine surgery despite the advent of minimally invasive techniques. Intra-operative CT scan will probably enhance the safety of the TDH surgery.
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Affiliation(s)
- Charlie Bouthors
- Orthopedic and Traumatology Surgery Department (Pr Ch Court), Bicetre University Hospital, Assistance Publique Hôpitaux de Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - Ahmed Benzakour
- Orthopedic and Traumatology Surgery Department (Pr Ch Court), Bicetre University Hospital, Assistance Publique Hôpitaux de Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - Charles Court
- Orthopedic and Traumatology Surgery Department (Pr Ch Court), Bicetre University Hospital, Assistance Publique Hôpitaux de Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
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35
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Lowe SR, Alshareef MA, Kellogg RT, Eriksson EA, Kalhorn SP. A Novel Surgical Technique for Management of Giant Central Calcified Thoracic Disk Herniations: A Dual Corridor Method Involving Tubular Transthoracic/Retropleural Approach Followed by a Posterior Transdural Diskectomy. Oper Neurosurg (Hagerstown) 2018; 16:626-632. [DOI: 10.1093/ons/opy225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/19/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Thoracic disk herniations (TDHs) represent only 0.15% to 1.8% of surgically managed disk herniations but have posed a particular challenge to spine surgeons. Numerous surgical approaches have been cited in the literature with varying degrees of success, technical complexity, and complication profiles.
OBJECTIVE
To report a case of a combined lateral retropleural and dorsal transdural approach for complex thoracic discectomy.
METHODS
In this report, we describe a combined lateral/retropleural and posterior transdural approach for a patient with a giant calcified TDH that was not amenable to safe removal using a single approach.
RESULTS
In complex situations such as this, a dual corridor approach allows for improved visualization and maximal resection opportunity and opens up yet another option to address recalcitrant TDH.
CONCLUSION
The staged dual corridor approach is safe and represents a further surgical option for extremely difficult TDH.
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Affiliation(s)
- Stephen R Lowe
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Mohammed A Alshareef
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Ryan T Kellogg
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Evert A Eriksson
- Department of General Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Stephen P Kalhorn
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
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Nahhas CR, Scheer JK, Khalid SI, Adogwa O, Arnone GD, Bhimani AD, Kheirkhah P, Mehta AI. Non-neurological outcomes of anterior and posterolateral approaches in the surgical treatment of thoracic disc disease: a retrospective study. JOURNAL OF SPINE SURGERY 2018; 4:241-246. [PMID: 30069513 DOI: 10.21037/jss.2018.05.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Symptomatic thoracic disc herniation (TDH) is rare, and for those patients that fail conservative treatment, two main categories of surgical approaches exist-anterior and posterolateral. In many cases either approach would be considered equally appropriate. Recommendations in support of either anterior or posterolateral approaches are currently based on case series and expert opinion. Here, we utilize National Surgical Quality Improvement Program (NSQIP) database to determine and compare the rates of complication associated with anterior or posterolateral approaches in the treatment of TDH. Methods An analysis of NSQIP data from 2005 to 2014 was conducted. Patients were included based on a combination of a postoperative diagnosis of TDH. Patients were then grouped according to anterior or posterior approaches on the basis of Current Procedural Terminology (CPT) codes. Propensity score matching was performed to account for baseline demographics [sex, race, age, obesity, diabetes, smoking, history of chronic obstructive pulmonary disease (COPD), history of CHF, and American Society of Anesthesiologists (ASA) class]. The 30-day outcome measures of these patients were analyzed. Results A total of 432 patients were identified, 80.3% underwent posterolateral and 19.7% anterior interventions. There were no significant differences in 30-day outcome measures between the anterior or posterior intervention groups. Within the matched group of 170 patients, the anterior group had significantly longer lengths of stay (5.49±3.96 vs. 4.01±4.81, P<0.0001), but there were no observed significant differences in the rate of occurrences of UTIs, pneumonias, sepsis, bleeding, intubation, or death. Conclusions Posterolateral and anterior approaches carry an equal non-neurological perioperative complication profile. Posterolateral approaches may carry shorter hospital stays compared to anterior interventions.
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Affiliation(s)
- Cindy R Nahhas
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Justin K Scheer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Gregory D Arnone
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Abhiraj D Bhimani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Pouyan Kheirkhah
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Oligane H, Rongo J, Agarwal V, Branstetter BF. Spontaneous regression of a large calcified thoracic disk extrusion. Skeletal Radiol 2018; 47:1177-1182. [PMID: 29442136 DOI: 10.1007/s00256-018-2887-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 02/02/2023]
Abstract
Although spontaneous regression of herniated disk material has been reported in the lumbar and cervical spine, reports of complete spontaneous regression of calcified thoracic disk herniations are exceedingly rare. In symptomatic patients, surgery is typically the treatment of choice; however, conservative therapy with surveillance may allow time for spontaneous resolution and potentially avoid high-risk surgery. We report a 40-year-old woman with complete spontaneous resolution of a large calcified thoracic disk extrusion with conservative management over an 8-month period.
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Affiliation(s)
- Hayley Oligane
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Jean Rongo
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Vikas Agarwal
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Barton F Branstetter
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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Ruetten S, Hahn P, Oezdemir S, Baraliakos X, Merk H, Godolias G, Komp M. Full-endoscopic uniportal decompression in disc herniations and stenosis of the thoracic spine using the interlaminar, extraforaminal, or transthoracic retropleural approach. J Neurosurg Spine 2018; 29:157-168. [PMID: 29856303 DOI: 10.3171/2017.12.spine171096] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgery for thoracic disc herniation and spinal canal stenosis is comparatively rare and often challenging. Individual planning and various surgical techniques and approaches are required. The key factors for selecting the technique and approach are anatomical location, consistency of the pathology, general condition of the patient, and the surgeon's experience. The objective of the study was to evaluate the technical implementation and outcomes of a full-endoscopic uniportal technique via the interlaminar, extraforaminal, or transthoracic retropleural approach in patients with symptomatic disc herniation and stenosis of the thoracic spine, taking specific advantages and disadvantages and literature into consideration. METHODS Between 2009 and 2015, decompression was performed in 55 patients with thoracic disc herniation or stenosis using a full-endoscopic uniportal technique via an interlaminar, extraforaminal, or transthoracic retropleural approach. Imaging and clinical data were collected during follow-up examinations for 18 months. RESULTS Sufficient decompression was achieved in the full-endoscopic uniportal technique. One patient required revision due to secondary bleeding, and another exhibited persistent deterioration on myelopathy. No other serious complications were observed. All but one patient experienced regression or improvement of their symptoms. CONCLUSIONS The full-endoscopic uniportal technique with an interlaminar, extraforaminal, or transthoracic retropleural approach was found to be a sufficient and minimally invasive method. To cover the entire range of thoracic disc herniations and stenosis within the criteria named, all full-endoscopic approaches are required.
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Affiliation(s)
- Sebastian Ruetten
- 1Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne
| | - Patrick Hahn
- 1Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne
| | - Semih Oezdemir
- 1Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne
| | - Xenophon Baraliakos
- 2Center for Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr University of Bochum, Herne
| | - Harry Merk
- 3Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald
| | - Georgios Godolias
- 4Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University Bochum/Marien Hospital Witten, Herne; and
| | - Martin Komp
- 5Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne, University of Witten/Herdecke, Herne, Germany
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39
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Anterior versus posterior approaches for thoracic disc herniation: Association with postoperative complications. Clin Neurol Neurosurg 2018; 167:17-23. [DOI: 10.1016/j.clineuro.2018.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/31/2018] [Accepted: 02/04/2018] [Indexed: 11/24/2022]
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40
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Ruetten S, Hahn P, Oezdemir S, Baraliakos X, Godolias G, Komp M. Decompression of the anterior thoracic spinal canal using a novel full-endoscopic uniportal transthoracic retropleural technique-an anatomical feasibility study in human cadavers. Clin Anat 2018; 31:716-723. [DOI: 10.1002/ca.23075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/16/2018] [Accepted: 03/13/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten; Herne 44649 Germany
| | - Patrick Hahn
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten; Herne 44649 Germany
| | - Semih Oezdemir
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten; Herne 44649 Germany
| | - Xenophon Baraliakos
- Center for Rheumatology, Rheumazentrum Ruhrgebiet; Ruhr University of Bochum; Herne 44649 Germany
| | - Georgios Godolias
- Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University Bochum/Marien Hospital Witten; Herne 44649 Germany
| | - Martin Komp
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten; Herne 44649 Germany
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Abstract
BACKGROUND Surgeries for symptomatic thoracic disk herniations (TDH) remain challenging. OBJECTIVE A mini-open lateral retropleural approach is described and the clinical outcomes are reported. MATERIALS AND METHODS A total of 23 patients underwent mini-open lateral retropleural diskectomy. Patients were placed in a lateral position. A 5-cm lateral incision was made followed by resection of the rib after careful dissection of its undersurface from the endothoracic fascia. The fascia was incised and separated from parietal pleura to widen the retropleural space. The rib head was removed followed by a pedicle resection below the TDH to expose the dura. A posterior partial corpectomy above and below the disk was performed to create a space ventral to the TDH, which was later dissected away from the dura and removed. RESULTS Fourteen males and 9 females comprised the clinical cohort. Five presented with axial back pain, 7 with radicular pain and 11 with myelopathy. All but 2 disks were successfully removed. The mean blood loss was 214cc and the mean hospital stay was 5.3 days. There was no mortality or new neurological deficits. The mean follow-up was 15.4 months. CONCLUSIONS Mini-open lateral retropleural approach is safe and effective to remove symptomatic TDH with minimal morbidities and fast patient recovery.
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42
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Cornips EM. Multilayer Dura Reconstruction After Thoracoscopic Microdiscectomy: Technique and Results. World Neurosurg 2018; 109:e691-e698. [DOI: 10.1016/j.wneu.2017.10.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/09/2017] [Accepted: 10/24/2017] [Indexed: 01/28/2023]
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43
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Cloney M, Hopkins B, Dhillon E, Dahdaleh NS. Outcomes of thoracic discectomy: A single center retrospective series. J Clin Neurosci 2017; 48:128-132. [PMID: 29150080 DOI: 10.1016/j.jocn.2017.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/02/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Cloney
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States.
| | - Benjamin Hopkins
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States
| | - Ekamjeet Dhillon
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States
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What are the possibilities of spontaneous resorption of a thoracic disc herniation occupying more than 20% of the spinal canal in the asymptomatic subject? Comparative study. J Clin Neurosci 2017; 44:269-273. [DOI: 10.1016/j.jocn.2017.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/18/2017] [Indexed: 11/18/2022]
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45
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Carr DA, Volkov AA, Rhoiney DL, Setty P, Barrett RJ, Claybrooks R, Bono PL, Tong D, Soo TM. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. Global Spine J 2017; 7:506-513. [PMID: 28894679 PMCID: PMC5582705 DOI: 10.1177/2192568217694140] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective consecutive case series. OBJECTIVE The objective of this case series was to demonstrate the safety of a modified transfacet pedicle-sparing decompression and instrumented fusion in patients with thoracic disc herniations (TDHs). METHODS Consecutive patients undergoing operative management of TDH from July 2007 to December 2011 using a posterior unilateral modified transfacet pedicle-sparing approach were identified. All patients underwent open or minimally invasive modified transfacet pedicle-sparing discectomy and segmental instrumentation with interbody fusion, performed by four different surgeons. Pre- and postoperative visual analog scale (VAS) pain scores, Nurick grade, and American Spinal Injury Association Impairment Scale (AIS) were analyzed from a retrospective chart review. Estimated blood loss and complications were also obtained. RESULTS Fifty-one patients were included that had operations for TDH. Thirty-nine patients had single level decompression and 12 had multilevel decompression. The total number of levels operated on was 64. Five patients were treated with minimally invasive surgery. A herniated disc level of T11-12 (n = 17) was treated most often. One major complication of epidural hematoma occurred. Minor complications such as malpositioned hardware, postoperative hematoma, wound infection, pseudoarthrosis, and pulmonary complications occurred in a few patients. Follow-up ranged from 1 to 46 months with 1 patient lost to follow-up. From preoperative to final postoperative: mean VAS scores improved from 8.31 to 4.05, AIS in all patients remained stable or improved, and Nurick scores improved from 3 to 2.6 on average. No intraoperative or permanent neurological deficit occurred. CONCLUSION In our surgical series, 51 consecutive patients underwent modified transfacet pedicle-sparing approach to TDHs and experienced improvement of functional status as well as improvement of objective pain scales with no neurological complications. The posterior unilateral modified transfacet pedicle-sparing decompression and instrumented fusion approach to the thoracic spine is a safe and reproducible procedure for the treatment of TDHs.
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Affiliation(s)
- Daniel A. Carr
- St John Providence Health System, Southfield, MI, USA,Daniel Carr, Section of Neurosurgery, Department of Surgery, St John Providence Health System, 16001 West 9 Mile Road, Southfield, MI 48075, USA.
| | | | | | - Pradeep Setty
- St John Providence Health System, Southfield, MI, USA
| | - Ryan J. Barrett
- St John Providence Health System, Southfield, MI, USA,Michigan Spine and Brain Surgeons, PLLC, Southfield, MI, USA
| | - Roderick Claybrooks
- St John Providence Health System, Southfield, MI, USA,Michigan Spine and Brain Surgeons, PLLC, Southfield, MI, USA
| | - Peter L. Bono
- St John Providence Health System, Southfield, MI, USA,Michigan Spine and Brain Surgeons, PLLC, Southfield, MI, USA
| | - Doris Tong
- Michigan Spine and Brain Surgeons, PLLC, Southfield, MI, USA
| | - Teck M. Soo
- St John Providence Health System, Southfield, MI, USA,Michigan Spine and Brain Surgeons, PLLC, Southfield, MI, USA
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Anterior Transthoracic Surgery with Motor Evoked Potential Monitoring for High-Risk Thoracic Disc Herniations: Technique and Results. World Neurosurg 2017; 105:441-455. [DOI: 10.1016/j.wneu.2017.05.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 11/23/2022]
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47
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Abstract
STUDY DESIGN A decision analysis. OBJECTIVE To perform a decision analysis utilizing postoperative complication data, in conjunction with health-related quality of life (HRQoL) utility scores, to rank order the average health utility associated with various surgical approaches used to treat symptomatic thoracic disk herniation (TDH). SUMMARY OF BACKGROUND DATA Symptomatic TDH is an uncommon entity accounting for <1% of all symptomatic herniated disks. A variety of surgical approaches have been developed for its treatment, which may be classified into 4 major categories: open anterolateral transthoracic, minimally invasive anterolateral thoracoscopic, posterior, and lateral. These treatments have varying risk/benefit profiles, but there is still no set algorithm for choosing an approach in cases with multiple surgical options. METHODS We searched Medline, EMBASE, and the Cochrane Library for relevant articles on surgical approaches for TDHs published between 1990 and August 2014. Pooled complication data and HRQoL utility scores associated with each complication were evaluated using standard meta-analytic techniques to determine which surgical approach resulted in the highest average HRQoL. RESULTS Posterior surgical approaches resulted in the highest average HRQoL, followed by thoracoscopic, lateral, and finally open anterolateral transthoracic procedures. The higher average HRQoL associated with posterior approaches over all others was highly significant (P<0.001); conversely, the open anterolateral approach resulted in a lower average postoperative utility compared with all other approaches (P<0.001). CONCLUSIONS The results of this decision analysis favor posterior over lateral approaches, and thoracoscopic over open anterolateral approaches for the treatment of symptomatic TDHs, which may guide surgeons in cases where multiple surgical options are feasible. Future studies, such as randomized clinical trials, are necessary to ascertain whether novel surgical strategies have risk/benefit profiles that ultimately supersede those of traditional approaches, and whether enough cases are encountered by the average surgeon to justify their adoption.
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48
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Combined intra-extradural approach for posterolateral thoracic disk herniations. Preliminary study and technical note. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:505-513. [PMID: 28331980 DOI: 10.1007/s00586-017-5041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
Abstract
Purpose Thoracic disk herniation is uncommon. It still represents a challenge for spinal surgeons. Multiple surgical strategies are available and, often, they are matter of debate. We describe a preliminary experience about a combined extra-intra dural approach for posterolateral disk herniation in patients affected by spinal cord compression. METHODS We performed a combined extra-intra dural approach in two preliminary cases. We performed bilateral laminectomy of adjacent vertebrae and unilateral partial medial arthrectomy of the involved segment. After a lateral extradural diskectomy, we, subsequently, performed a median longitudinal durotomy. The conflict between disk herniation and spinal cord was identified. We removed disk herniation moving disk fragments in the extradural compartment without ventral spinal dura opening. RESULTS We solved spinal cord compression in both cases. Postoperative neurological improvement was observed in both cases. No major complications were observed. CONCLUSION Our preliminary results are probably insufficient to establish surgical criteria but offer another surgical perspective to especially treat patients with contraindication to anterior approaches.
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49
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Pei B, Sun C, Xue R, Xue Y, Zhao Y, Zong YQ, Lin W, Wang P. Circumferential Decompression via a ModifiedCostotransversectomy Approach for the Treatment of Single Level Hard Herniated Disc between T10 -L1. Orthop Surg 2017; 8:34-43. [PMID: 27028379 DOI: 10.1111/os.12223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe a novel surgical strategy for circumferentially decompressing the T10 -L1 spinal canal when impinged upon by single level hard thoracic herniated disc (HTHD) via a modified costotransversectomy approach. METHODS This is a retrospective review of 26 patients (17 men, 9 women; mean age at surgery 48.5 years, range 20-77 years) who had undergone single level HTHD between T10 -L1 by circumferential decompression via a modified costotransversectomy approach. The characteristics of the approach are using a posterior midline covered incision, which keeps the paraspinal muscle intact and ensures direct visualization of circumferential spinal cord decompression of single level HTHD between T10 -L1 . RESULTS The average operative time was 208 ± 36 min (range, 154-300 min), mean blood loss 789 ± 361 mL (range, 300-2000 mL), mean preoperative and postoperative mJOA scores 5.2 ± 1.5 and 9.0 ± 1.3, respectively (t = 19.7, P < 0.05). The rate of recovery of neurological function ranged from 33.3% to 100%. The ASIA grade improved in 24 patients (92.3%) and stabilized (no grade change) in two (7.7%). MRI indicated that the cross-sectional area of the dural sac at the level of maximum compression increased from 45.0 ± 5.8 mm(2) preoperatively to 113.5 ± 6.1 mm(2) postoperatively (t = 68.2, P < 0.05). Anterior tibialis muscle strength of the 15 patients with foot drop had a mean recovery rate of 95% at final follow-up. One patient who resumed work early after the surgery showed a significantly augmented Cobb angle. One patient had transient postoperative cerebrospinal fluid leakage. No patients showed neurological deterioration. CONCLUSIONS This procedure achieves sufficient direct visualization for circumferential decompression of the spinal cord via a posterior midline covered costotransversectomy approach with friendly bleeding control and without muscle sacrifice. It is a reasonable alternative treatment option for thoracic myelopathy caused by single level HTHD between T10 -L1 .
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Affiliation(s)
- Bo Pei
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Sun
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Ruoyan Xue
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Zhao
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Ya-qi Zong
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Lin
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Pei Wang
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
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50
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Innocenzi G, D'Ercole M, Cardarelli G, Bistazzoni S, Ricciardi F, Marzetti F, Sasso F. Transpedicular Approach to Thoracic Disc Herniaton Guided by 3D Navigation System. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017; 124:327-331. [PMID: 28120092 DOI: 10.1007/978-3-319-39546-3_48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND The choice of surgical approach for thoracic disc herniation should consider the location on the axial plane and the consistency of the herniated disc. Calcified midline disc herniations are difficult to remove with a transpedicular approach because of limitations due to blind spots; so they are usually treated via a transthoracic approach, although this entails a high risk of thoracopulmonary injuries. METHODS In this work we present two cases of calcified midline thoracic disc herniations treated with a transpedicular approach, improved by using a three-dimensional (3D) neuronavigation system to verify the extent of removal on the blind side. RESULTS Postoperative computed tomography (CT) scans demonstrated that this original technical innovation, in the two present cases, allowed us to reach the side opposite the disc herniation and to assess the extent of resection at the end of the procedure. CONCLUSIONS The employment of a neuronavigation system in the transpedicular approach allowed safe and effective removal of calcified midline thoracic disc herniations. We did not observe any postoperative neurological worsening, onset of spinal instability, or other adverse events.
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Affiliation(s)
- Gualtiero Innocenzi
- Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy.
| | - Giovanni Cardarelli
- Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy
| | - Simona Bistazzoni
- Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy
| | - Francesco Ricciardi
- Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy
| | - Francesco Marzetti
- Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy
| | - Francesco Sasso
- Department of Orthopaedics and Traumatology, University of Naples "Federico II", Naples, Italy
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