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A Journal on Neurosurgery

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Journal of Neurosurgical Sciences 1999 March;43(1):37-43

language: English

Thoracic disc herni­a­tion. Unilateral trans­ped­i­cu­lar ­approach in 35 con­sec­u­tive ­patients

Levi N., Gjerris F., Dons K.

Department of Neurosurgery, Rigshospitalet, University of Copenhagen, Denmark


Background. Thoracic disc her­ni­a­tion is uncom­mon and sur­gery for tho­rac­ic disc her­ni­a­tion rep­re­sents less than 1-2% of oper­a­tions for disc dis­ease. However, there is no con­sen­sus on the best ­approach and ­reports are based on small ­series.
Methods. A con­sec­u­tive ­series of 35 tho­rac­ic disc her­ni­a­tions (25 in women and 10 in men) were treat­ed ­between 1991 and 1996 using the trans­ped­i­cu­lar ­approach and fol­lowed in a pros­pec­tive study. All ­patients had a pre­op­er­a­tive MRI exam­ina­tion. The mean age was 51 years. The T6-7 and T7-8 level were the most fre­quent local­iza­tion. The inter­val ­between onset of symp­toms and oper­a­tion ­ranged from 6 weeks to 4 years with a mean of 18 ­months. Presenting symp­toms on admis­sion was radic­u­lop­a­thy in 12 ­patients and mye­lop­a­thy in 23 ­patients. Severe uri­nary symp­toms were found in 2 ­patients, mod­er­ate symp­toms in 9 ­patients, mild symp­toms in 3 ­patients and 21 ­patient had no uri­nary symp­toms.
Results. One ­patient was para­ple­gic imme­di­ate­ly after sur­gery and she made no fur­ther improve­ment. A good ­result was found in 15 ­patients, a fair ­result was found in a fur­ther 11 ­patients but in 8 ­patients the out­come was ­unchanged with no ­effect of a reop­er­a­tion in two cases. No clin­i­cal or radio­graph­ic fea­tures of instabil­ity were found. The post­op­er­a­tive ­course was unevent­ful, ­except in one ­patient with a wound ­abscess lead­ing to dis­citis.
Conclusions. The trans­ped­i­cu­lar ­approach can be an effec­tive and safe meth­od of sur­gi­cal decom­pres­sion in care­ful­ly select­ed ­patients.

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