Surgical management of giant herniated thoracic discs: analysis of 20 cases

被引:116
作者
Hott, JS [1 ]
Feiz-Erfan, I [1 ]
Kenny, K [1 ]
Dickman, CA [1 ]
机构
[1] St Josephs Hosp, Barrow Neurol Inst, Div Neurol Surg, Phoenix, AZ 85013 USA
关键词
thoracic spine; intervertebral disc; disc herniation; thoracoscopy; thoracotomy; posterolateral approach;
D O I
10.3171/spi.2005.3.3.0191
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. The authors evaluated the clinical and surgical outcomes obtained in patients with giant herniated thoracic discs (HTDs), defined as occupying more than 40% of the spinal canal. Surgery-related considerations and functional outcomes in patients with small- and medium-sized HTDs were compared. Methods. The authors reviewed 140 cases of surgically treated HTDs, 20 (14%) of which were giant. Before and after surgery, all patients underwent computerized tomography myelography, magnetic resonance imaging, or both. Functional outcomes were assessed using the Frankel grading system preoperatively, immediately after surgery, and at long-term follow-up examination. The results observed in patients with giant HTDs were compared with those with small- and medium-sized HTDs. The mean overall follow-up period was 2.6 years. Sixty-six patients (47%) presented with myelopathy, including 19 (95%) with a giant HTD. Of the latter, 16 (80%) underwent anterior, eight thoracoscopic, and eight open thoracotomy approaches. Four patients (20%) with laterally oriented giant HTDs within the spinal canal underwent surgery via a posterolateral approach. Based on analysis of long-term follow-up data, 53% of patients with giant HTDs improved neurologically by one Frankel grade. Progression of myelopathy was arrested in 42%, and in 5% the Frankel grade worsened by one. In patients with small- and medium-sized HTDs, the Frankel grade improved by one in 77%, stabilized in 23%, and worsened in 0%. Patients with giant HTDs who underwent thoracoscopic surgery had worse short- and long-term functional outcomes than those in whom open thoracotomy was performed. Conclusions. Patients with giant HTDs presented more frequently with myelopathy and experienced worse functional outcomes than those with smaller HTDs. Based on their experience, the authors recommend open thoracotomy rather than thoracoscopy for the treatment of midline giant HTDs.
引用
收藏
页码:191 / 197
页数:7
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