Spinal cord decompression by minimally invasive transthoracic lateral approach. Case report
Abstract
There are multiple techniques for spinal cord decompression in the thoracic spine, each with its advantages and disadvantages, and requiring different surgical skills. Recently, minimally invasive techniques have been developed, reducing morbidity rates and achieving good functional results. We present the case of a 64-year-old male with spinal compression symptoms, central disc herniation calcified at the fifth thoracic vertebra, which migrated to the lower end of the sixth thoracic vertebra. Diagnosis was clear for spinal cord compression. Partial posterior corpectomy of the sixth vertebra was performed with a minimally invasive transthoracic transpleural lateral approach and without additional fixation. The patient had a good outcome on follow-up, without progression of neurological symptoms or residual rib pain. Minimally invasive lateral approaches are valid techniques for the treatment of compression disorders of the thoracic spine, with low rates of morbidity and mortality, and a rapid recovery.Downloads
References
Louge V. Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 1952;15(4):227-41. DOI:10.1136/jnnp.15.4.227
Arseni C, Nash F. Thoracic intervertebral disc protrusion: a clinical study. J Neurosurg 1960;17:418-30.
DOI: 10.3171/jns.1960.17.3.0418
Hulme A. The surgical approach to thoracic intervertebral disc protrusions. J Neurosurg Psychiatry 1960;23:133-7. Doi: 10.1136/jnnp.23.2.133
Le roux PD, Haglund MM, Harris AB. Thoracic disc disease: experience with the transpedicular approach in twenty
consecutive patients. Neurosurgery 1993;33:58-66. DOI:10.1097/00006123-199307000-00009
Perot Jr PL, Munro DD. Transthoracic removal of midline thoracic disc protrusions causing spinal cord compression. J Neurosurg 1969;31:452-8. DOI:10.3171/jns.1969.31.4.0452
Rosenthal D, Rosenthal R, de Simone A. Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine 1994;19(9):1087-91. DOI: 10.1097/00007632-199405000-00018
Dakwar E, Ahmadian A, Uribe JS. The anatomical relationship of the diaphragm to the thoracolumbar junction during the minimally invasive lateral extracelomic (retropleural/retroperitoneal) approach. J Neurosurg Spine 2012;16:359-64.
DOI: 10.3171/2011.12.SPINE11626
Uribe JS, Smith WD, Pimenta L, Hartl R, Dakwar E, Modhia UM. Minimally invasive lateral approach for symptomatic thoracic disc herniation: initial multi-center clinical experience. J Neurosurg Spine 2012;16:264-79. DOI: 10.3171/2011.10.SPINE11291
Karmakar MK, Ho AM. Postthoracotomy pain syndrome. Thora Surg Clin 2004;14:345-52. DOI:10.1016/S1547-4127(04)00022-2
Hann PP, Kenny K, Dickman CA. Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures. Neurosurgery 2002;52(Suppl 5):88-95. DOI:10.1097/00006123-200211002-00013
McAfee PC, Regan JR, Zdeblick T, Zuckerman J, Picetti GD 3rd, Heim S, et al. The incidence of complications in endoscopic anterior thoracolumbar spinal reconstructive surgery. A prospective multicenter study comprising the first 100 consecutive cases. Spine (Phila PA 1976) 1995;20:1624-32. DOI:10.1097/00007632-199507150-00012
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 2011;24:E40-8.
DOI: 10.1097/BSD.0b013e318220af6f
Nacar OA, Ulu MO, Pekmezci M, Deviren V. Surgical treatment of thoracic disc disease via minimally invasive lateral transthoracic trans/retropleural approach: analysis of 33 patients. Neurosurg Rev 2013;36:455-65. DOI: 10.1007/s10143-013-0461-2
Uribe JS, Dakwar E, Le TV, Christian G, Serrano S, Smith WD. Minimally invasive surgery treatment for thoracic spine tumor removal: a mini-open, lateral approach. Spine 2010;35:S347-54. DOI: 10.1097/BRS.0b013e3182022d0f
White AA III, Panjabi MM. Clinical biomechanics of the spine, 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 1990. ISBN-10: 0397507208
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