Mini-Open Retropleural Transthoracic Approach for the Treatment of Giant Thoracic Disc Herniation

Study Design. We report on all patients treated for giant thoracic disc herniation in the past 10 years. Objective. To specifically discuss our management of thoracic discs that occupy more than 40% of the canal and are thus defined as "giant" and to compare our surgical approach and technique with the previously published case series. Summary of Background Data. Giant herniated thoracic discs (HTDs) are recognized as a particular subset of thoracic disc pathology that require unique surgical consideration given their large volume, their often calcified nature, and the fact that the vast majority of patients have an already compromised spinal cord. It has been recommended that for successful resection of these discs an open thoracotomy, followed by a 2-level corpectomy and instrumentation, be performed. In the past decade, our institution has managed giant HTDs differently, using a mini-open retropleural thoracotomy, without the need for vertebrectomy or instrumentation in any case. Methods. Seventeen cases of surgically treated giant HTDs were included in this study. Frankel grading system, 36-Item Short Form Health Survey, and Oswestry Disability Index assessed functional outcomes. Results. Seventeen patients underwent resection of a giant HTD between 2001 and 2010. The median postoperative length of stay was 5.5 days. All patients were myelopathic on presentation, Frankel scores ranged from B to D preoperatively. On long-term follow-up, 13 patients had improvement of their neurological status by 1 or 2 grades, 3 patients had no change in grade, and 1 patient died 38 days postoperation from pneumonia. No patient had neurological deterioration on long-term follow-up. Conclusion. Anterior exposure of the thoracic spine using a mini-open thoracotomy and retropleural approach coupled with a limited bony resection surrounding the giant disc, without corpectomy or instrumentation, represents an effective, safe, and appropriate surgical treatment for the resection of giant thoracic discs.