Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Ultrasound-Guided Posterolateral Approach for Midline Calcified Thoracic Disc Herniation

  • Tan, Lee A. (Department of Neurosurgery, Rush University Medical Center) ;
  • Lopes, Demetrius K. (Department of Neurosurgery, Rush University Medical Center) ;
  • Fontes, Ricardo B.V. (Department of Neurosurgery, Rush University Medical Center)
  • Received : 2013.12.07
  • Accepted : 2014.06.11
  • Published : 2014.06.28
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Abstract

Objective : Symptomatic thoracic disc herniation often requires prompt surgical treatment to prevent neurological deterioration and permanent deficits. Anterior approaches offer direct visualization and access to the herniated disc and anterior dura but require access surgeons and are often associated with considerable postoperative pain and pulmonary complications. A disadvantage with using posterior approaches in the setting of central calcified thoracic disc herniation however, has been the limited visualization of anterior dura and difficulty to accurately assess the extent of decompression. Methods : We report our experience with intraoperative ultrasound (US) guidance during a modified posterior transpedicular approach for removal of a central calcified thoracic disc herniation with a review of pertinent literature. Results : The herniated thoracic disc was successfully removed with posterior approach with the aid of intraoperative US. The patient had significant neurological improvement at three months follow-up. Conclusion : Intraoperative ultrasound is a simple yet valuable tool for real-time imaging during transpedicular thoracic discectomy. Visualization provided by intraoperative US increases the safety profile of posterior approaches and may make thoracotomy unnecessary in a selected group of patients, especially when a patient has existing pulmonary disease or is otherwise not medically fit for the transthoracic approach.

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References

  1. Anand N, Regan JJ : Video-assisted thoracoscopic surgery for thoracic disc disease : Classification and outcome study of 100 consecutive cases with a 2-year minimum follow-up period. Spine (Phila Pa 1976) 27 : 871-879, 2002 https://doi.org/10.1097/00007632-200204150-00018
  2. Arce CA, Dohrmann GJ : Thoracic disc herniation. Improved diagnosis with computed tomographic scanning and a review of the literature. Surg Neurol 23 : 356-361, 1985 https://doi.org/10.1016/0090-3019(85)90206-X
  3. Ayhan S, Nelson C, Gok B, Petteys RJ, Wolinsky JP, Witham TF, et al. : Transthoracic surgical treatment for centrally located thoracic disc herniations presenting with myelopathy : a 5-year institutional experience. J Spinal Disord Tech 23 : 79-88, 2010 https://doi.org/10.1097/BSD.0b013e318198cd4d
  4. Benson MK, Byrnes DP : The clinical syndromes and surgical treatment of thoracic intervertebral disc prolapse. J Bone Joint Surg Br 57 : 471-477, 1975
  5. Bilsky MH : Transpedicular approach for thoracic disc herniations. Neurosurg Focus 9 : e3, 2000
  6. Carson J, Gumpert J, Jefferson A : Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 34 : 68-77, 1971 https://doi.org/10.1136/jnnp.34.1.68
  7. Chi JH, Dhall SS, Kanter AS, Mummaneni PV : The Mini-Open transpedicular thoracic discectomy : surgical technique and assessment. Neurosurg Focus 25 : E5, 2008
  8. Deviren V, Kuelling FA, Poulter G, Pekmezci M : Minimal invasive anterolateral transthoracic transpleural approach : a novel technique for thoracic disc herniation. A review of the literature, description of a new surgical technique and experience with first 12 consecutive patients. J Spinal Disord Tech 24 : E40-E48, 2011 https://doi.org/10.1097/BSD.0b013e318220af6f
  9. Dickman CA, Rosenthal D, Regan JJ : Reoperation for herniated thoracic discs. J Neurosurg 91 (2 Suppl) : 157-162, 1999 https://doi.org/10.3171/jns.1999.91.1.0157
  10. Fessler RG, Sturgill M : Review : complications of surgery for thoracic disc disease. Surg Neurol 49 : 609-618, 1998 https://doi.org/10.1016/S0090-3019(97)00434-5
  11. Gooding GA, Boggan JE, Weinstein PR : Intraoperative sonography during lumbar laminectomy : work in progress. AJNR Am J Neuroradiol 5 : 751-753, 1984
  12. Hulme A : The surgical approach to thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 23 : 133-137, 1960 https://doi.org/10.1136/jnnp.23.2.133
  13. Jefferson A : The treatment of thoracic intervertebral disc protrusions. Clin Neurol Neurosurg 78 : 1-9, 1975 https://doi.org/10.1016/S0303-8467(75)80002-3
  14. Jho HD : Endoscopic microscopic transpedicular thoracic discectomy. Technical note. J Neurosurg 87 : 125-129, 1997 https://doi.org/10.3171/jns.1997.87.1.0125
  15. Kasliwal MK, Deutsch H : Minimally invasive retropleural approach for central thoracic disc herniation. Minim Invasive Neurosurg 54 : 167-171, 2011 https://doi.org/10.1055/s-0031-1284400
  16. Lesoin F, Rousseaux M, Autricque A, Reesaul Y, Villette L, Clarisse J, et al. : Thoracic disc herniations : evolution in the approach and indications. Acta Neurochir (Wien) 80 : 30-34, 1986 https://doi.org/10.1007/BF01809554
  17. Logue V : Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 15 : 227-241, 1952 https://doi.org/10.1136/jnnp.15.4.227
  18. Love JG, Kiefer EJ : Root pain and paraplegia due to protrusions of thoracic intervertebral disks. J Neurosurg 7 : 62-69, illust, 1950 https://doi.org/10.3171/jns.1950.7.1.0062
  19. Mack MJ, Regan JJ, Bobechko WP, Acuff TE : Application of thoracoscopy for diseases of the spine. Ann Thorac Surg 56 : 736-738, 1993 https://doi.org/10.1016/0003-4975(93)90966-L
  20. McCormick PC : Retropleural approach to the thoracic and thoracolumbar spine. Neurosurgery 37 : 908-914, 1995 https://doi.org/10.1227/00006123-199511000-00009
  21. Mixter WJ, Barr JS : Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211 : 210-215, 1934 https://doi.org/10.1056/NEJM193408022110506
  22. Montalvo BM, Quencer RM, Brown MD, Sklar E, Post MJ, Eismont F, et al. : Lumbar disk herniation and canal stenosis : value of intraoperative sonography in diagnosis and surgical management. AJR Am J Roentgenol 154 : 821-830, 1990 https://doi.org/10.2214/ajr.154.4.2107683
  23. Patterson RH Jr, Arbit E : A surgical approach through the pedicle to protruded thoracic discs. J Neurosurg 48 : 768-772, 1978 https://doi.org/10.3171/jns.1978.48.5.0768
  24. Raynor RB : Intraoperative ultrasound for immediate evaluation of anterior cervical decompression and discectomy. Spine (Phila Pa 1976) 22 : 389-395, 1997 https://doi.org/10.1097/00007632-199702150-00006
  25. Reid MH : Ultrasonic visualization of a cervical cord cystic astrocytoma. AJR Am J Roentgenol 131 : 907-908, 1978 https://doi.org/10.2214/ajr.131.5.907
  26. Stone JL, Lichtor T, Banerjee S : Intradural thoracic disc herniation. Spine (Phila Pa 1976) 19 : 1281-1284, 1994 https://doi.org/10.1097/00007632-199405310-00016
  27. Tian W, Weng C, Liu B, Li Q, Sun YQ, Yuan Q, et al. : Intraoperative 3-dimensional navigation and ultrasonography during posterior decompression with instrumented fusion for ossification of the posterior longitudinal ligament in the thoracic spine. J Spinal Disord Tech 26 : E227-E234, 2013 https://doi.org/10.1097/BSD.0b013e318286ba39
  28. Tovi D, Strang RR : Thoracic intervertebral disk protrusions. Acta Chir Scand Suppl Suppl 267 : 1-41, 1960
  29. Uribe JS, Smith WD, Pimenta L, Hartl R, Dakwar E, Modhia UM, et al. : Minimally invasive lateral approach for symptomatic thoracic disc herniation : initial multicenter clinical experience. J Neurosurg Spine 16 : 264-279, 2012 https://doi.org/10.3171/2011.10.SPINE11291

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