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International Orthopaedics

Published in:

01-04-2019 | Review

Surgical treatment of thoracic disc herniation: an overview

Authors: Charlie Bouthors, Ahmed Benzakour, Charles Court

Published in: International Orthopaedics | Issue 4/2019

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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Title: Surgical treatment of thoracic disc herniation: an overview
Authors: Charlie Bouthors
Ahmed Benzakour
Charles Court
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4224-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Surgical treatment of thoracic disc herniation: an overview

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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