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KEY FACTS
Pre-Procedure
Outcomes
TERMINOLOGY
Definitions
Multiple techniques
Posterior approaches
Laminectomy
No longer performed for thoracic disc herniations
Increased risk of neurologic injury (25-75%)
Cord manipulation for approach to ventral disease may interfere with cord blood supply
Kyphotic deformities cause tethering of cord over incompletely removed disc/osteophyte
Transpedicular
Less extensive procedure
Limited access to midline
Transforaminal
Less extensive procedure
Limited access to midline
Transfacet
Less extensive procedure
Limited access to midline
Posterolateral
Costotransversectomy
Greater ventral access
Increased muscle and rib resection
Lateral extracavitary
Greater ventral access
Increased muscle/rib dissection
Anterior
Transthoracic
Excellent ventral access
Extensive surgery with potential of increased morbidity
Favored for central thoracic herniations with myelopathy and calcification
Varieties
Transpleural
Extrapleural
Transsternal
Thorascopic
PRE-PROCEDURE
Indications
Pre-Procedure Imaging
PROCEDURE
Alternative Procedures/Therapies
OUTCOMES
Problems
Selected References
Arnold PM et al: Surgical management of multiple thoracic disc herniations via a transfacet approach: a report of 15 cases. J Neurosurg Spine. 15(1):76-81, 2011
Cornips EM et al: Thoracic disc herniation and acute myelopathy: clinical presentation, neuroimaging findings, surgical considerations, and outcome. J Neurosurg Spine. 14(4):520-8, 2011
Diabira S et al: Brown-Sequard syndrome revealing intradural thoracic disc herniation. Eur Spine J. 20(1):65-70, 2011
Khoo LT et al: Minimally invasive extracavitary approach for thoracic discectomy and interbody fusion: 1-year clinical and radiographic outcomes in 13 patients compared with a cohort of traditional anterior transthoracic approaches. J Neurosurg Spine. 14(2):250-60, 2011
Binning MJ et al: Percutaneous placement of radiopaque markers at the pedicle of interest for preoperative localization of thoracic spine level. Spine (Phila Pa 1976). 35(19):1821-5, 2010
Bransford R et al: Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. J Neurosurg Spine. 12(2):221-31, 2010
Choi KY et al: Percutaneous endoscopic thoracic discectomy; transforaminal approach. Minim Invasive Neurosurg. 53(1):25-8, 2010
Machino M et al: A new thoracic reconstruction technique "transforaminal thoracic interbody fusion": a preliminary report of clinical outcomes. Spine (Phila Pa 1976). 35(19):E1000-5, 2010
Baranto A et al: Acute chest pain in a top soccer player due to thoracic disc herniation. Spine (Phila Pa 1976). 34(10):E359-62, 2009
Barbanera A et al: Giant calcified thoracic herniated disc: considerations aiming a proper surgical strategy. J Neurosurg Sci. 53(1):19-25; discussion 25-6, 2009
Burke TG et al: Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique. Neurosurg Focus. 9(4):e9, 2000
McCormick WE et al: Surgery for thoracic disc disease. Complication avoidance: overview and management. Neurosurg Focus. 9(4):e13, 2000
Vollmer DG et al: Transthoracic approaches to thoracic disc herniations. Neurosurg Focus. 9(4):e8, 2000
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Pre-Procedure
Outcomes
TERMINOLOGY
Definitions
Multiple techniques
Posterior approaches
Laminectomy
No longer performed for thoracic disc herniations
Increased risk of neurologic injury (25-75%)
Cord manipulation for approach to ventral disease may interfere with cord blood supply
Kyphotic deformities cause tethering of cord over incompletely removed disc/osteophyte
Transpedicular
Less extensive procedure
Limited access to midline
Transforaminal
Less extensive procedure
Limited access to midline
Transfacet
Less extensive procedure
Limited access to midline
Posterolateral
Costotransversectomy
Greater ventral access
Increased muscle and rib resection
Lateral extracavitary
Greater ventral access
Increased muscle/rib dissection
Anterior
Transthoracic
Excellent ventral access
Extensive surgery with potential of increased morbidity
Favored for central thoracic herniations with myelopathy and calcification
Varieties
Transpleural
Extrapleural
Transsternal
Thorascopic
PRE-PROCEDURE
Indications
Pre-Procedure Imaging
PROCEDURE
Alternative Procedures/Therapies
OUTCOMES
Problems
Selected References
Arnold PM et al: Surgical management of multiple thoracic disc herniations via a transfacet approach: a report of 15 cases. J Neurosurg Spine. 15(1):76-81, 2011
Cornips EM et al: Thoracic disc herniation and acute myelopathy: clinical presentation, neuroimaging findings, surgical considerations, and outcome. J Neurosurg Spine. 14(4):520-8, 2011
Diabira S et al: Brown-Sequard syndrome revealing intradural thoracic disc herniation. Eur Spine J. 20(1):65-70, 2011
Khoo LT et al: Minimally invasive extracavitary approach for thoracic discectomy and interbody fusion: 1-year clinical and radiographic outcomes in 13 patients compared with a cohort of traditional anterior transthoracic approaches. J Neurosurg Spine. 14(2):250-60, 2011
Binning MJ et al: Percutaneous placement of radiopaque markers at the pedicle of interest for preoperative localization of thoracic spine level. Spine (Phila Pa 1976). 35(19):1821-5, 2010
Bransford R et al: Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. J Neurosurg Spine. 12(2):221-31, 2010
Choi KY et al: Percutaneous endoscopic thoracic discectomy; transforaminal approach. Minim Invasive Neurosurg. 53(1):25-8, 2010
Machino M et al: A new thoracic reconstruction technique "transforaminal thoracic interbody fusion": a preliminary report of clinical outcomes. Spine (Phila Pa 1976). 35(19):E1000-5, 2010
Baranto A et al: Acute chest pain in a top soccer player due to thoracic disc herniation. Spine (Phila Pa 1976). 34(10):E359-62, 2009
Barbanera A et al: Giant calcified thoracic herniated disc: considerations aiming a proper surgical strategy. J Neurosurg Sci. 53(1):19-25; discussion 25-6, 2009
Burke TG et al: Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique. Neurosurg Focus. 9(4):e9, 2000
McCormick WE et al: Surgery for thoracic disc disease. Complication avoidance: overview and management. Neurosurg Focus. 9(4):e13, 2000
Vollmer DG et al: Transthoracic approaches to thoracic disc herniations. Neurosurg Focus. 9(4):e8, 2000
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