Abstract
Surgery for thoracic disc herniations is still challenging, and the disc excision via a posterior laminectomy is considered risky. A variety of dorsolateral and ventral approaches have been developed. However, the lateral extracavitary and transthoracic approach require extensive surgical exposure. Therefore, we adopted a posterior transdural approach for direct visualization without entry into the thoracic cavity. Three cases that illustrate this procedure are reported here with the preoperative findings, radiological findings and surgical techniques used. After the laminectomy, at the involved level, the dorsal dura was opened with a longitudinal paramedian incision. The cerebrospinal fluid was drained to gain more operating space. After sectioning of the dentate ligaments, gentle retraction was applied to the spinal cord. Between the rootlets above and below, the ventral dural bulging was clearly observed. A small paramedian dural incision was made over the disc space and the protruded disc fragment was removed. Neurological symptoms were improved, and no surgery-related complication was encountered. The posterior transdural approach may offer an alternative surgical option for selected patients with thoracic paracentral soft discs, while limiting the morbidity associated with the exposure.
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References
Almond LM, Hamid NA, Wasserberg J (2007) Thoracic intradural disc herniation. Br J Neurosurg 21:32–34
Anand N, Regan JJ (2002) 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 27:871–879
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
Choi JW, Lee JK, Moon KS, Hur H, Kim YS, Kim SH (2007) Transdural approach for calcified central disc herniations of the upper lumbar spine. Technical note. J Neurosurg 7:370–374
Choudhari KA, Fannin TF, Byrnes DP (2001) Transradicular interfascicular approach for lumbar microdiscectomy: a useful technique in difficult circumstances. Br J Neurosurg 15:360–362
De Palma AF, Rothman RH (1970) The intervertebral disc. W. B. Saunders, Philadelphia
Fessler RG, Sturgill M (1998) Review: complications of surgery for thoracic disc disease. Surg Neurol 49:609–618
Fox MW, Onofrio BM (1994) Transdural approach to the anterior spinal canal in patients with cervical spondylotic myelopathy and superimposed central soft disc herniation. Neurosurgery 34:634–641 (discussion 641–632)
Fujimoto Y, Baba I, Sumida T, Tanaka N, Oka S, Kawagoe H (2002) Microsurgical transdural discectomy with laminoplasty: new treatment for paracentral and paracentroforaminal cervical disc herniation associated with spinal canal stenosis. Spine 27:715–721
Hamilton MG, Thomas HG (1990) Intradural herniation of a thoracic disc presenting as flaccid paraplegia: case report. Neurosurgery 27:482–484
Horwitz NH, Whitcomb BB, Reilly FG (1955) Ruptured thoracic discs. Yale J Biol Med 28:322–330
Isaacs RE, Podichetty VK, Sandhu FA, Santiago P, Spears JD, Aaronson O, Kelly K, Hrubes M, Fessler RG (2005) Thoracic microendoscopic discectomy: a human cadaver study. Spine 30:1226–1231
Isla A, Roda JM, Bencosme J, Alvarez MP, Blazquez MG (1988) Intradural herniated dorsal disc: case report and review of the literature. Neurosurgery 22:737–739
Jho HD (1999) Endoscopic transpedicular thoracic discectomy. J Neurosurg 91:151–156
Le Roux PD, Haglund MM, Harris AB (1993) Thoracic disc disease: experience with the transpedicular approach in twenty consecutive patients. Neurosurgery 33:58–66
Logue V (1952) Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 15:227–241
Maiman DJ, Larson SJ, Luck E, El-Ghatit A (1984) Lateral extracavitary approach to the spine for thoracic disc herniation: report of 23 cases. Neurosurgery 14:178–182
McCormick WE, Will SF, Benzel EC (2000) Surgery for thoracic disc disease. Complication avoidance: overview and management. Neurosurg Focus 9:e13
Negovetic L, Cerina V, Sajko T, Glavic Z (2001) Intradural disc herniation at the T1–T2 level. Croat Med J 42:193–195
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
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Moon, SJ., Lee, JK., Jang, JW. et al. The transdural approach for thoracic disc herniations: a technical note. Eur Spine J 19, 1206–1211 (2010). https://doi.org/10.1007/s00586-010-1294-0
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DOI: https://doi.org/10.1007/s00586-010-1294-0