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Full-Endoscopic Transforaminal Ventral Decompression for Symptomatic Thoracic Disc Herniation with or without Calcification: Technical Notes and Case Series. Pain Res Manag 2021; 2021:6454760. [PMID: 34777672 PMCID: PMC8580684 DOI: 10.1155/2021/6454760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
Background Symptomatic thoracic disc herniation is a challenge in spinal surgery, especially for cases with calcification. Traditional open operation has a high complication rate. The authors introduced a modified full-endoscopic transforaminal ventral decompression technique in this study and evaluated its imaging and clinical outcomes. Materials and Methods Eleven patients with symptomatic thoracic disc herniation who underwent full-endoscopic transforaminal ventral decompression in a single medical center were enrolled. The surgical technique was performed as described in detail. Dilator sliding punching, endoscope-monitored foraminoplasty, and base cutting through the “safe triangle zone” are the key points of the technique. Clinical outcomes were assessed by the modified Japanese Orthopedic Association (mJOA) score for neurological improvement and the visual analogy score (VAS) for thoracic and leg pain. The operation time, hospital stay, and complications were also analyzed. Results Postoperative magnetic resonance imaging (MRI) revealed good decompression of the spinal cord. The mJOA improved from 7.4 (range: 5–10) to 10.2 (range: 9–11). Axial thoracic pain improved in 8 of 9 patients. Leg pain and thoracic radicular pain improved in all patients. No complications were observed. The average operation time was 136 minutes (range: 70–180 minutes). The average length of hospital stay was 5.3 days (range: 2–8 days). Conclusion Minimally invasive full-endoscopic transforaminal ventral decompression for the treatment of symptomatic thoracic disc herniation with or without calcification is feasible and may be another option for this challenging spine disease.
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Nakhla J, Bhashyam N, De la Garza Ramos R, Nasser R, Kinon MD, Yassari R. Minimally invasive transpedicular approach for the treatment of central calcified thoracic disc disease: a technical note. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1575-1585. [PMID: 29247397 DOI: 10.1007/s00586-017-5406-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/23/2017] [Accepted: 11/18/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the utility of stereotactic navigation for the surgical treatment of ossified, paracentral thoracic discs via a minimally invasive (MI) transpedicular approach. METHODS The authors performed a retrospective review of cases with paracentral thoracic disc herniation resulting in myelopathy where a traditional MI approach would be difficult, who underwent a stereotactic assisted MI transpedicular approach via a tubular retractor system between 2011 and 2016. Five cases of patients over the age of 18 were selected. Collected data included patient age at surgery, sex, preoperative Nurick grade, number of levels treated, calcified disc presence, length of surgery, estimated blood loss (EBL), length of stay (LOS), complication rate, postoperative Nurick grade, and length of follow-up. RESULTS Five patients had a stereotaxic assisted MI transpedicular thoracic discectomy for paracentrally located calcified disc herniation. Intraoperative navigational images were acquired using intraoperative CT scans (O-arm) to plan and guide the surgical procedure, and real-time navigation was used for precise navigation around the cord to access and remove all fragments. MIS surgery was successfully performed in these otherwise contraindicated cases due to the use of intraoperative real-time stereotactic navigation. All patients had a successful decompression around the anterior aspect of the cord. CONCLUSION The traditional MI transpedicular thoracic discectomy approach can be further refined and enhanced by stereotactic navigation to expand the limitations of the MIS technique allowing for an increased number and types of patients eligible for minimally invasive surgery. Therefore, MIS via a tubular retractor system with stereotactic navigation is a novel, safe, and effective improvement in feasibility from the traditional minimally invasive transpedicular thoracic discectomy technique.
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Affiliation(s)
- Jonathan Nakhla
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY, 10467, USA
| | - Niketh Bhashyam
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY, 10467, USA
| | - Rafael De la Garza Ramos
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY, 10467, USA
| | - Rani Nasser
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY, 10467, USA
| | - Merritt D Kinon
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY, 10467, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA. .,Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY, 10467, USA.
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Combined intra-extradural approach for posterolateral thoracic disk herniations. Preliminary study and technical note. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:505-513. [PMID: 28331980 DOI: 10.1007/s00586-017-5041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
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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Woodbury A, McKenzie-Brown AM. Extradural thoracic spinal lesion presenting as low back and leg pain. PAIN MEDICINE 2014; 16:1030-2. [PMID: 25546132 DOI: 10.1111/pme.12671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Woodbury
- Department of Anesthesiology and Pain Management, Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Anne Marie McKenzie-Brown
- Department of Anesthesiolgoy and Center for Pain Management, Emory University, Atlanta, Georgia, USA
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