Abstract
Problem
Thoracic disc disease with radicular pain and myelopathic symptoms can have serious neurological sequelae. The authors present a relevant treatment option.
Methods
Data of patients with single level symptomatic thoracic disc herniation treated with thoracoscopic microdiscectomy were prospectively collected over a period of 10 years. Data collection included the preoperative status and the follow-up status was 6, 12 and 24 months after surgery for every patient.
Results
A total of 167 single level thorascoscopic discectomies without previous surgery on the level of the procedure were included in this study. The average preoperative duration of pain symptoms was 14.3 months, myelopathic symptoms were present for an average of 16.7 months before surgery. After the procedure pain scores measured with visual analog scale (VAS) decreased by 4.4 points and the muscle strength improved by a mean of 4.6 points (American Spinal Injury Association ASIA motor score). After 2 years, 79% of the patients reported a excellent or good outcome for pain and 80% of the patients reported a excellent or good outcome for motor function. The overall complication rate was 15.6%.
Conclusions
Thoracoscopic microdiscectomy for single level symptomatic disc herniation is a highly effective and reliable technique, it can be performed safely with low complication rate.
Similar content being viewed by others
References
Abbott KH, Retter RH (1956) Protrusions of thoracic intervertebral disks. Neurology 1:1–10
Anand N, Regan JJ (2002) Video-assisted thoracoscopic surgery for thoracic disc disease. Spine 27(8):871–879
Arce CA, Dohrmann GJ (1985) Thoracic disc herniation: Improved diagnosis with computed tomographic scanning and a review of the literature. Surg Neurol 23:356–361
Arseni C, Nash F (1995) Thoracic intervertebral disc protrusion: a clinical study. J Neurosurg 17:418–430
Ayhan S, Nelson C et al (2010) Transthoracic surgical treatment for centrally located thoracic disc herniations presenting with myelopathy. A 5-year institutional experience. J Spinal Disord Tech 23(2):79–88
Balagué F, Fankhauser H (1989) Unusual presentation of thoracic disc herniation. Clin Rheumatol 8(2):269–273
Broc GG, Crawford NR, Sonntag VK, Dickman CA (1997) Biomechanical effects of transthoracic microdiscectomy. Spine 22(6):605–612
Carson J, Gumpert J, Jefferson A (1971) Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 34:68–77
Eichholz KM, O’toole JE, Fessler RG (2006) Thoracic microendoscopic discectomy. Neurosurg Clin N Am 17(4):441–446
Fessler RG, Sturgill M (1998) Review: complications of surgery for thoracic disc disease. Surg Neurol 49(6):609–618
Gille O, Soderlund C, Razafimahandri HJ, Mangione P, Vital JM (2006) Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy. Eur Spine J 15(5):537–542
Horton WC, Kraiwattanapong C et al (2005) The role of the sternum, costosternal articulations, intervertebral discand facets in thoracic sagittal plane biomechanics. A comparison of three different sequences of surgical release. Spine 30(18):2014–2023
Longo UG, Papapietro N, Maffulli N, Denaro V (2009) Thoracoscopy for minimally invasive thoracic spine surgery. Orthop Clin North Am 40(4):459–464
Oskouian RJ, Johnson JP (2005) Endoscopic thoracic microdiscectomy. J Neurosurg Spine 3(6):459–464
Regan JJ, Ben-Yishay A, Mack MJ (1998) Video assisted thoracoscopic excision of herniated thoracic disc: description of technique and preliminary experience in the first 29 cases. J Spinal Disord 11:183–191
Rosenthal D, Rosenthal R, de Simone A (1994) Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine 19(9):1087–1091
Rosenthal D, Dickman CA (1998) Thoracoscopic microsurgical excision of herniated thoracic discs. J Neurosurg 89(2):224–235
Sheikh H, Samartzis D, Perez-Cruet MJ (2007) Techniques for the operative management of thoracic disc herniation: minimally invasive thoracic microdiscectomy. Orthop Clin North Am 38:351–361
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
Stillerman CB, Weiss MH (1992) Management of thoracic disc disease. Clin Neurosurg 38:325–352
Theodore N, Dickman CA (1996) Current management of thoracic disc herniation. Contemp Neurosurg 18(19):1–7
Williams MP, Cherryman GR, Husband JE (1989) Significance of thoracic disc herniation demonstrated by MR imaging. J Comput Tomog 13:211–214
Wood KB, Blair JM, Aepple DM (1997) The natural history of asymptomatic thoracic disc herniations. Spine 22(5):525–530
Garfin SR, Vaccaro AR (1997) Orthopaedic knowledge update. In: North American Spine Society Spine (ed) Imaging studies of the spine, Rosemont, IL (ISBN 0-89203-169-7)
Li AL, Yen D (2011) Effect of increased MRI and CT scan utilization on clinical decision-making in patients referred to a surgical clinic for back pain. Can J Surg 54(2):128–132
Conflict of interest
No funds were received in support of this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Quint, U., Bordon, G., Preissl, I. et al. 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 (2012). https://doi.org/10.1007/s00586-011-2103-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-011-2103-0