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Giant central thoracic disc herniations: surgical outcome in 17 consecutive patients treated by mini-thoracotomy
Roland Roelz1, Christoph Scholz2, Jan-Helge Klingler2
1Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. roland.roelz@uniklinik-freiburg.de.
Insights
Mini-thoracotomy offers a safe and effective surgical solution for giant central thoracic disc herniations (cTDH). This approach leads to significant functional improvement in patients with thoracic myelopathy.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Thoracic Spine Pathology
Background:
- Giant central thoracic disc herniations (cTDH) present significant surgical challenges.
- Calcification and intradural extension are common in cTDH, complicating treatment.
- Limited surgical exposure and experience with cTDH add to the complexity.
Purpose of the Study:
- To evaluate the 10-year experience with mini-thoracotomy for managing giant cTDH.
- To describe the surgical technique for mini-thoracotomy in cTDH cases.
- To assess the safety and efficacy of this approach.
Main Methods:
- Retrospective review of 17 patients with giant cTDH treated between 2004 and 2014.
- All patients underwent surgery via mini-thoracotomy.
- Functional outcomes were assessed using the modified Japanese Orthopedic Association (mJOA) score.
Main Results:
- Complete removal of cTDH was achieved in all 17 patients.
- The mean mJOA score improved significantly from 7.9 to 11.1.
- Transient neurological decline occurred in two patients; severe complications and incisional pain were rare.
Conclusions:
- Mini-thoracotomy is a safe and effective treatment for myelopathy caused by giant cTDH.
- The technique is technically straightforward, facilitating learning for experienced spine surgeons.
- This approach offers a favorable alternative to more complex surgical methods.
Purpose:
Safe treatment of giant central thoracic disc herniations (cTDHs) remains a surgical challenge due to frequent calcifications, intradural extension and, importantly, the rare exposure of spine surgeons to these lesions. We report our 10-year experience in the management of giant cTDH by mini-thoracotomy and offer a detailed description of the technique.
Methods:
17 patients harboring 17 giant cTDH operated on via a mini-thoracotomy at the authors' institution between 2004 and 2014 were reviewed. All patients presented with myelopathy of varying magnitude. Mean patient age was 47 years. The mean follow-up period was 5.5 years. Median canal compromise of the cTDH was 66 %. cTDH were densely calcified in 7 (41 %), partially calcified in 6 (35 %) and soft in 4 (24 %) patients. Intradural extension of cTDH was noted in six patients (35 %). Benzels' modified myelopathy score of the Japanese Orthopedic Association was adjusted for the evaluation of thoracic myelopathy (mJOA) to assess functional outcomes.
Results:
Successful removal of the offending cTDH was achieved in all patients. The overall mJOA Score improved from 7.9/13 to 11.1/13. Two patients with giant and densely calcified cTDH experienced a transient post-operative neurological decline. There was a statistically significant correlation between size of cTDH and intradural extension.
Conclusion:
Patients with myelopathy due to giant cTDH can be safely treated by the mini-thoracotomy approach. Postoperative neurological worsening and severe complications or incisional pain are rare. In contrast to complex posterior or thoracoscopic approaches, the mini-thoracotomy is technically straightforward and thus easy to learn for experienced spine surgeons.
