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Combined intra-extradural approach for posterolateral thoracic disk herniations. Preliminary study and technical note

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Abstract

Purpose Thoracic disk herniation is uncommon. It still represents a challenge for spinal surgeons. Multiple surgical strategies are available and, often, they are matter of debate. We describe a preliminary experience about a combined extra-intra dural approach for posterolateral disk herniation in patients affected by spinal cord compression.

Methods

We performed a combined extra-intra dural approach in two preliminary cases. We performed bilateral laminectomy of adjacent vertebrae and unilateral partial medial arthrectomy of the involved segment. After a lateral extradural diskectomy, we, subsequently, performed a median longitudinal durotomy. The conflict between disk herniation and spinal cord was identified. We removed disk herniation moving disk fragments in the extradural compartment without ventral spinal dura opening.

Results

We solved spinal cord compression in both cases. Postoperative neurological improvement was observed in both cases. No major complications were observed.

Conclusion

Our preliminary results are probably insufficient to establish surgical criteria but offer another surgical perspective to especially treat patients with contraindication to anterior approaches.

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References

  1. Carson J, Gumpert J, Jefferson A (1971) Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 34:68–77

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Oppenlander ME, Clark JC, Kalyvas J, Dickman CA (2016) Indications and Techniques for Spinal Instrumentation in Thoracic Disk Surgery. Clin Spine Surg. 29(2):E99–E106. doi:10.1097/BSD.0000000000000110

    PubMed  Google Scholar 

  3. Lee Sung-Jun MoonJung-Kil, Jae-Won Jang Hyuk, Lee HurJae-Hyun (2010) The transdural approach for thoracic disc herniations: a technical note. Eur Spine J 19:1206. doi:10.1007/s00586-010-1294-0

    Article  PubMed  PubMed Central  Google Scholar 

  4. Coppes MH, Bakker NA, Metzemaekers JD, Groen RJ (2012) Posterior transdural discectomy: a new approach for the removal of a central thoracic disc herniation. Eur Spine J 21(4):623–628. doi:10.1007/s00586-011-1990-4

    Article  PubMed  Google Scholar 

  5. Mehdian, SMH (2012) Reviewer’s comment concerning “Posterior transdural discectomy: a new approach for the removal of a central thoracic disc herniation.” (doi:10.1007/s00586-011-1990-4 by H.M. Coppes et al.). Eur Spine J 21:629. doi:10.1007/s00586-011-1999-8

  6. Yoshihara(2014) H Surgical treatment for thoracic disc herniation: an update. Spine (Phila Pa 1976) 39(6):E406–E412. doi:10.1097/BRS.0000000000000171

  7. Arce CA, Dohrmann GJ (1985) Herniated thoracic disks. Neurol Clin 3:383–392

    CAS  PubMed  Google Scholar 

  8. Mehdian H, Nasto LA (2016) Surgical management of thoracic disc herniation. Eur Spine J 25(Suppl 4):483–485

  9. Nayak NR, Bauman JA, Stein SC et al (2016). Surgical Approaches for the Treatment of Thoracic Disk Herniation: Results of a Decision Analysis [Record Supplied By Publisher] Clin Spine Surg, Mar 25 [epub ahead of print]

  10. Bydon M, Gokaslan Z (2014) Minimally invasive approaches in the treatment of thoracic disk herniation. World Neurosurg (United States) 81(5-6):717–718

  11. Vollmer DG, Simmons NE (2000) Transthoracic approaches to thoracic disc herniations. Neurosurg Focus 9:e8

    Article  CAS  PubMed  Google Scholar 

  12. Levi N, Gjerris F, Dons K (1999) Thoracic disc herniation. Unilateral transpedicular approach in 35 consecutive patients. J Neurosurg Sci 43:37–42

    CAS  PubMed  Google Scholar 

  13. 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

    Article  CAS  PubMed  Google Scholar 

  14. Benzel EC, Perry TG.(2013)Minimally invasive thoracic microendoscopic diskectomy: a tool for all surgeons? World Neurosurg 80(3-4):319–321. doi:10.1016/j.wneu.2013.01.059

  15. Smith JS, Eichholz KM, Shafizadeh S, Ogden AT, O’Toole JE, Fessler RG (2013) Minimally invasive thoracic microendoscopic diskectomy: surgical technique and case series. World Neurosurg 80(3–4):421–427. doi:10.1016/j.wneu.2012.05.031

    Article  PubMed  Google Scholar 

  16. Yang SD, Chen Q, Ning SH, Ding WY, Yang DL (2016) Modified eggshell procedure via posterior approach for sclerosing thoracic disc herniation: a preliminary study. J Orthop Surg Res 11(1):102. doi:10.1186/s13018-016-0438-2

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Authors and Affiliations

  1. P.O. Santa Maria Delle Grazie, ASL Napoli2 Nord, Loc. La Schiana, Pozzuoli, 80078, NA, Italy

    Antonio Bocchetti, Valentina Cioffi & Raffaele de Falco

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  1. Antonio Bocchetti
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  2. Valentina Cioffi
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  3. Raffaele de Falco
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Correspondence to Antonio Bocchetti.

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Bocchetti, A., Cioffi, V. & de Falco, R. Combined intra-extradural approach for posterolateral thoracic disk herniations. Preliminary study and technical note. Eur Spine J 26 (Suppl 4), 505–513 (2017). https://doi.org/10.1007/s00586-017-5041-7

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  • DOI: https://doi.org/10.1007/s00586-017-5041-7

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