Abstract
Thoracic disc herniations are a relatively rare occurrence compared to disc herniations in the cervical or lumbar spine. Surgical management of these thoracic herniations can be technically difficult with a wide array of reported complications. In this study, we aim to describe the most common complications that can occur during or after surgical management of thoracic disc herniations. Furthermore, we describe tips and tricks for avoidance and, if necessary, management of surgical complications. Common complications addressed in this review include vertebral column instability, neurologic injury, cerebrospinal fluid leak/pleural fistula, thoracic viscera injury, wrong level surgery, incomplete disk resection, and intercostal neuralgia.
Similar content being viewed by others
References
Dietze DD Jr, Fessler RG (1993) Thoracic disc herniations. Neurosurg Clin N Am 4:75–90. https://doi.org/10.1016/S1042-3680(18)30609-0
Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR (2010) Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. J Neurosurg Spine 12:221–231. https://doi.org/10.3171/2009.9.SPINE09476
Cornips EM, Janssen ML, Beuls EA (2011) Thoracic disc herniation and acute myelopathy: clinical presentation, neuroimaging findings, surgical considerations, and outcome. J Neurosurg Spine 14:520–528. https://doi.org/10.3171/2010.12.SPINE10273
Hulme A (1960) The surgical approach to thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 23:133–137. https://doi.org/10.1136/jnnp.23.2.133
Love JG, Kiefer EJ (1950) Root pain and paraplegia due to protrusions of thoracic intervertebral disks. J Neurosurg 7:62–69. https://doi.org/10.3171/jns.1950.7.1.0062
Currier BL, Eismont FJ, Green BA (1994) Transthoracic disc excision and fusion for herniated thoracic discs. Spine 19:323–328. https://doi.org/10.1097/00007632-199402000-00012
el-Kalliny M, Tew JM Jr, van Loveren H, Dunsker S (1991) Surgical approaches to thoracic disc herniations. Acta Neurochir 111:22–32. https://doi.org/10.1007/BF01402509
Maiman DJ, Larson SJ, Luck E, El-Ghatit A (1984) Lateral extracavitary approach to the spine for thoracic disc herniation: report of 23 cases. Neurosurgery 14:178–182. https://doi.org/10.1097/00006123-198402000-00010
Mulier S, Debois V (1998) Thoracic disc herniations: transthoracic, lateral, or posterolateral approach? A review. Surg Neurol 49:599–608. https://doi.org/10.1016/S0090-3019(98)00008-1
Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH (1998) Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg 88:623–633. https://doi.org/10.3171/jns.1998.88.4.0623
Stillerman CB, Chen TC, Day JD, Couldwell WT, Weiss MH (1995) The transfacet pedicle-sparing approach for thoracic disc removal: cadaveric morphometric analysis and preliminary clinical experience. J Neurosurg 83:971–976. https://doi.org/10.3171/jns.1995.83.6.0971
He B, Yan L, Xu Z, Guo H, Liu T, Hao D (2014) Treatment strategies for the surgical complications of thoracic spinal stenosis: a retrospective analysis of two hundred and eighty three cases. Int Orthop 38:117–122. https://doi.org/10.1007/s00264-013-2103-
Nayak NR, Bauman JA, Stein SC, Thawani JP, Malhotra NR (2017) Surgical approaches for the treatment of thoracic disk herniation: results of a decision analysis. Clin Spine Surg 30:E901–E908. https://doi.org/10.1097/BSD.0000000000000375
Ridenour TR, Haddad SF, Hitchon PW, Piper J, Traynelis VC, VanGilder JC (1993) Herniated thoracic disks: treatment and outcome. J Spinal Disord 6:218–224. https://doi.org/10.1097/00002517-199306030-00006
Ayhan S, Nelson C, Gok B, Petteys RJ, Wolinskiy JP, Witham TF, Bydon A, Gokaslan ZL, Sciubba DM (2010) Transthoracic surgical treatment for centrally located thoracic disc herniations presenting with myelopathy: a 5-year institutional experience. J Spinal Disord Tech 23:79–88. https://doi.org/10.1097/BSD.0b013e318198cd4d
Vollmer DG, Simmons NE (2000) Transthoracic approaches to thoracic disc herniations. Neurosurg Focus 9:e8. https://doi.org/10.3171/foc.2000.9.4.8
Yang X, Liu X, Zheng Y (2014) Surgical treatment of thoracic disc herniations using a modified transfacet approach. Indian J Orthop 48:158–162. https://doi.org/10.4103/0019-5413.128756
Fessler RG, Sturgill M (1998) Review: complications of surgery for thoracic disc disease. Surg Neurol 49:609–618. https://doi.org/10.1016/S0090-3019(97)00434-5
Turgut M (1998) Three-level thoracic disc herniation: case report and review of the literature (P. G. Korovessis et al., ESJ 1997, Vol. 6, p. 74-76). Eur Spine J 7:348–350. https://doi.org/10.1007/s005860050087
Maiman DJ, Pintar FA (1992) Anatomy and clinical biomechanics of the thoracic spine. Clin Neurosurg 38:296–324
Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8:817–831. https://doi.org/10.1097/00007632-198311000-00003
Berg EE (1993) The sternal-rib complex. A possible fourth column in thoracic spine fractures. Spine 18:1916–1919. https://doi.org/10.1097/00007632-199310000-00033
Takeuchi T, Abumi K, Shono Y, Oda I, Kaneda K (1999) Biomechanical role of the intervertebral disc and costovertebral joint in stability of the thoracic spine. A canine model study. Spine 24:1414–1420. https://doi.org/10.1097/00007632-199907150-00005
Liebsch C, Graf N, Appelt K, Wilke HJ (2017) The rib cage stabilizes the human thoracic spine: an in vitro study using stepwise reduction of rib cage structures. PLoS One 12:e0178733. https://doi.org/10.1371/journal.pone.0178733
Arce CA, Dohrmann GJ (1985) Herniated thoracic disks. Neurol Clin 3:383–392. https://doi.org/10.1016/S0733-8619(18)31043-0
Court C, Mansour E, Bouthors C (2018) Thoracic disc herniation: surgical treatment. Orthop Traumatol Surg Res 104:S31–S40. https://doi.org/10.1016/j.otsr.2017.04.022
Vanichkachorn JS, Vaccaro AR (2000) Thoracic disk disease: diagnosis and treatment. J Am Acad Orthop Surg 8:159–169. https://doi.org/10.5435/00124635-200005000-00003
Krauss WE, Edwards DA, Cohen-Gadol AA (2005) Transthoracic discectomy without interbody fusion. Surg Neurol 63:403–409. https://doi.org/10.1016/j.surneu.2004.06.026
Quraishi NA, Khurana A, Tsegaye MM, Boszczyk BM, Mehdian SM (2014) Calcified giant thoracic disc herniations: considerations and treatment strategies. Eur Spine J 23(Suppl 1):S76–S83. https://doi.org/10.1007/s00586-014-3210-5
Logue V (1952) Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 15:227–241. https://doi.org/10.1136/jnnp.15.4.227
Al-Mahfoudh R, Mitchell PS, Wilby M, Crooks D, Barrett C, Pillay R, Pigott T (2016) Management of giant calcified thoracic disks and description of the trench vertebrectomy technique. Global Spine J 6:584–591. https://doi.org/10.1055/s-0035-1570087
Hott JS, Feiz-Erfan I, Kenny K, Dickman CA (2005) Surgical management of giant herniated thoracic discs: analysis of 20 cases. J Neurosurg Spine 3:191–197. https://doi.org/10.3171/spi.2005.3.3.0191
Quint U, Bordon G, Preissl I, Sanner C, Rosenthal D (2012) Thoracoscopic treatment for single level symptomatic thoracic disc herniation: a prospective followed cohort study in a group of 167 consecutive cases. Eur Spine J 21:637–645. https://doi.org/10.1007/s00586-011-2103-0
Gille O, Soderlund C, Razafimahandri JH, Mangione P, Vital JM (2006) Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy. Eur Spine J 15:537–542. https://doi.org/10.1007/s00586-005-1014-3
Roelz R, Scholz C, Klingler JH, Scheiwe C, Sircar R, Hubbe U (2016) Giant central thoracic disc herniations: surgical outcome in 17 consecutive patients treated by mini-thoracotomy. Eur Spine J 25:1443–1451. https://doi.org/10.1007/s00586-016-4380-0
Strom RG, Mathur V, Givans H, Kondziolka DS, Perin NI (2015) Technical modifications and decision-making to reduce morbidity in thoracic disc surgery: an institutional experience and treatment algorithm. Clin Neurol Neurosurg 133:75–82. https://doi.org/10.1016/j.clineuro.2015.03.014
Moon SJ, Lee JK, Jang JW, Hur H, Lee JH, Sim SH (2010) The transdural approach for thoracic disc herniations: a technical note. Eur Spine J 19:1206–1211. https://doi.org/10.1007/s00586-010-1294-0
McCormick WE, Will SF, Benzel EC (2012) Surgery for thoracic disc disease. Complication avoidance: overview and management. Neurosurg Focus 9:e13. https://doi.org/10.3171/foc.2000.9.4.13
Yoshihara H, Honeoka D (2014) Incidental dural tear in spine surgery: analysis of a nationwide database. Eur Spine J 23:389–394. https://doi.org/10.1007/s00586-013-3091-z
Rosenthal D, Rosenthal R, de Simone A (1994) Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine 19:10887–11991. https://doi.org/10.1097/00007632-199405000-00018
Hentschel SJ, Rhines LD, Wong FC, Gokaslan ZL, McCutcheon IE (2004) Subarachnoid-pleural fistula after resection of thoracic tumors. J Neurosurg 100(4 Suppl Spine):332–326
Kurata Y, Yoshimoto M, Takebayashi T, Kawaguchi S, Yamashita T (2010) Subarachnoid-pleural fistula treated with noninvasive positive pressure ventilation: a two-case report and literature review. Spine 35:E908–E911. https://doi.org/10.1097/BRS.0b013e3181dc57c1
Shamji MF, Sundaresan S, Da Silva V, Seely J, Shamji FM (2011, 2011) Subarachnoid-pleural fistula: applied anatomy of the thoracic spinal nerve root. ISRN Surg:168959. https://doi.org/10.5402/2011/168959
Rabassa AE, Nusynowitz ML (2005) Detection of subarachnoid pleural fistula. Neuroradiol 33:83–84. https://doi.org/10.1007/BF00593345
Nyunoya T, Gross T, Rooney C, Mendoza S, Kline J (2003) Massive pleural transudate following a vertebral fusion in a 49-year-old woman. Chest 123:1280–1283. https://doi.org/10.1378/chest.123.4.1280
Sahota S, Nassr A, Khan MH, Marsh RW, Moran SL, Arnold PM, Dekutoski MB (2012) Treatment of a thoracic dural-pleural fistula with a vascularized omental flap: a case report. Spine 37:E683–E685. https://doi.org/10.1097/BRS.0b013e31824a3f73
Stillerman CB, Weiss MH (1992) Management of thoracic disc disease. Clin Neurosurg 38:325–352
Dickman CA, Rosenthal D, Regan JJ (1999) Reoperation for herniated thoracic discs. J Neurosurg 91(2 Suppl):157–162
Johnson JP, Drazin D, King WA, Kim TT (2014) Image-guided navigation and video-assisted thoracoscopic spine surgery: the second generation. Neurosurg Focus 36:E8. https://doi.org/10.3171/2014.1.FOCUS13532
Bouthors C, Benzakour A, Court C (2018) Surgical treatment of thoracic disc herniation: an overview. Int Orthop. https://doi.org/10.1007/s00264-018-4224-0
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there is no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
None of the above authors have relevant financial disclosures pertaining to this investigation. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Rights and permissions
About this article
Cite this article
Robinson, W.A., Nassr, A.N. & Sebastian, A.S. Thoracic disc herniation, avoidance, and management of the surgical complications. International Orthopaedics (SICOT) 43, 817–823 (2019). https://doi.org/10.1007/s00264-018-04282-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-018-04282-x