Summary
Early diagnosis of thoracic disc herniations has become more common with the advent of spinal magnetic resonance imaging (MRI). This early diagnosis combined with choosing the optimal surgical approach, to ensure adequate decompression without excessive cord and root manipulation, will achieve the optimum results. It is now clear that more lateral and anterior approaches to the thoracic spine are required to achieve this goal.
We report our experience in the operative management of 21 patients with thoracic disc herniation using three different surgical approaches: transpedicular-transfacetal, posterolateral-extrapleural (costotransversectomy) and transthoracic-transpleural. The clinical and radiologic findings and results in all of our cases are reviewed as are the technique of and indication for each of the three surgical approaches.
Similar content being viewed by others
References
Arce CA, Dohrmann GJ (1985) Thoracic disc herniation. Surg Neurol 23: 356–361
Arseni C, Nash F (1960) Thoracic intervertebral disc protrusions: A clinical study. J Neurosurg 17: 418–430
Barnett GH, Hardy RW Jr., Little JRet al (1987) Thoracic spinal canal stenosis. J Neurosurg 66: 338–344
Benjamin V, Ransohoff J (1982) Thoracic disc disease. In: Rothman RH, Simeone FA (eds) The Spine, Vol 1, 19, W. B. Saunders Company, Philadelphia, pp 500–507
Benson MKD, Byrnes DP (1975) The clinical syndromes and surgical treatment of thoracic intervertebral disc prolapse. J Bone Joint Surg 57B: 471–477
Blumenkopf B (1988) Thoracic intervertebral disc herniations, diagnostic value of magnetic resonance imaging. Neurosurgery 23: 36–40
Capener N (1954) The evolution of lateral rhachotomy. J Bone Joint Surg 36B: 173–179
Caron JP, Djindjian R, Julina Het al (1971) Les hernies discales dorsales. Ann Med Intern (Paris) 22: 675–688
Carson JP, Gumpert J, Jefferson A, Julian Het al (1971) Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 34: 68–77
Crafoord C, Hiertonn T, Lindblom K, Olsson SE (1958) Spinal cord compression caused by a protruded thoracic disc. Report of a case treated with antero-lateral fenestration of the disc. Acta Orthop Scand 28: 103–107
Crock HWJ, Yoshizawa H (1977) The blood supply of the vertebral column and spinal cord in man. Springer, Wien New York
De Palma AF, Rothman RH (1970) The intervertebral disc. W. B. Saunders Company, pp 171–180
Gowers WR (1892) Diseases of the nervous system, 2nd ed, Vol 1. Churchill, London, 260 pp
Hawk WA (1936) Spinal compression caused by ecchondrosis of the intervertebral fibrocartilage with a review of the recent literature. Brain 59: 204–224
Hulme A (1960) The surgical approach to thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 23: 133–137
Larson SJ, Hoist RA, Hemmy DCet al (1976) Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine. J Neurosurg 45: 628–637
Lazorthes G, Poulhes J, Eastide G, Chanholle AR, Zadeh O (1962) La vascularization de la Moele Epiniere Pathologic Vasculaire de la Molle. XXV Reunion Neurologique Internationale, Masson et Cie, Paris, pp 5–27
Lobosky JM, Hitchon PW, McDonnell DE (1984) Transthoracic anterolateral decompression of thoracic spinal lesions. J Neurosurg 14: 26–30
Logue V (1952) Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 15: 227–241
Louis R (1983) Surgery of the spine. Surgical anatomy and operative approaches. Springer, Berlin Heidelberg New York, pp 24–66
Love JG, Keifer EJ (1950) Root pain and paraplegia due to protrusions of thoracic intervertebral discs. J Neurosurg 7: 62–69
Love JG, Schorn VG (1965) Thoracic-disc protrusions. JAMA 191: 627–631
Menard V (1900) Etude pratique sur le mal de pott. Paris
Middleton GS, Teacher JH (1911) Injury of the spinal cord due to rupture of an intervertebral disc during muscular effort. Glasgow Med J 76: 1–6
Mixter WJ, Barr JS (1934) Rupture of intervertebral disc with involvement of the spinal canal. N Engl J Med 211: 210–215
Muller R (1951) Protrusion of thoracic intervertebral discs with compression of the spinal cord. Acta Med Scand 139: 99–104
Patterson RH, Arbit E (1978) A surgical approach through the pedicle to protruded thoracic discs. J Neurosurg 48: 768–772
Perot P, Munro DD (1969) Transthoracic removal of midline thoracic disc protrusions causing spinal cord compression. J Neurosurg 31: 452–458
Ransohoff J, Spencer F, Siew F, Gage L (1969) Transthoracic disc protrusions causing spinal cord compression. J Neurosurg 31: 459–461
Seddon HJ (1936) Pott's paraplegia; prognosis and treatment. Br J Surg 22: 769–799
Sekhar LN, Janetta PJ (1983) Thoracic disc herniations: Operative approaches and results. J Neurosurg 12, 3: 303–305
Tovi D, Strang RR (1960) Thoracic intervertebral disc protrusions. Acta Chir Scand [Suppl] 267: 1–41
Van Landingham JH (1954) Herniation of thoracic intervertebral discs with spinal cord compression in the kyphosis dorsalis juvenilis (Scheuermann's disease). Case Report. J Neurosurg 11: 327–329
Verbiest H (1954) A radicular syndrome from development narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br) 36: 230–237
William MP, Cherrman CR, Husband JE (1989) Significance of thoracic disc herniation demonstrated by MR Imaging. J Comp Assist Tomogr 13(2): 211–214
Yablon JS, Kasdon DL, Levine H (1984) Thoracic cord compression in Scheuermann's disease. Spine 13: 896–898
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
El-Kalliny, M., Tew, J.M., van Loveren, H. et al. Surgical approaches to thoracic disc herniations. Acta neurochir 111, 22–32 (1991). https://doi.org/10.1007/BF01402509
Issue Date:
DOI: https://doi.org/10.1007/BF01402509