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Surgical treatment of thoracic disc herniation: an overview.
- Source :
-
International orthopaedics [Int Orthop] 2019 Apr; Vol. 43 (4), pp. 807-816. Date of Electronic Publication: 2018 Nov 08. - Publication Year :
- 2019
-
Abstract
- Background: Surgical treatment of thoracic disc herniation (TDH) is technically demanding due to its proximity to the spinal cord.<br />Methods: Literature review.<br />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.<br />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.
- Subjects :
- Female
Humans
Intervertebral Disc Degeneration
Lung
Magnetic Resonance Imaging
Male
Postoperative Complications surgery
Thoracoscopy
Tomography, X-Ray Computed
Treatment Outcome
Decompression, Surgical methods
Intervertebral Disc Displacement surgery
Spinal Cord Diseases surgery
Thoracic Vertebrae surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1432-5195
- Volume :
- 43
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- International orthopaedics
- Publication Type :
- Academic Journal
- Accession number :
- 30406842
- Full Text :
- https://doi.org/10.1007/s00264-018-4224-0