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Thoracic Herniation Approaches
Jeffrey S. Ross, MD
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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

              1. 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
              2. 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
              3. Diabira S et al: Brown-Sequard syndrome revealing intradural thoracic disc herniation. Eur Spine J. 20(1):65-70, 2011
              4. 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
              5. 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
              6. 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
              7. Choi KY et al: Percutaneous endoscopic thoracic discectomy; transforaminal approach. Minim Invasive Neurosurg. 53(1):25-8, 2010
              8. 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
              9. 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
              10. 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
              11. Burke TG et al: Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique. Neurosurg Focus. 9(4):e9, 2000
              12. McCormick WE et al: Surgery for thoracic disc disease. Complication avoidance: overview and management. Neurosurg Focus. 9(4):e13, 2000
              13. 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

                          1. 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
                          2. 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
                          3. Diabira S et al: Brown-Sequard syndrome revealing intradural thoracic disc herniation. Eur Spine J. 20(1):65-70, 2011
                          4. 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
                          5. 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
                          6. 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
                          7. Choi KY et al: Percutaneous endoscopic thoracic discectomy; transforaminal approach. Minim Invasive Neurosurg. 53(1):25-8, 2010
                          8. 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
                          9. 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
                          10. 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
                          11. Burke TG et al: Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique. Neurosurg Focus. 9(4):e9, 2000
                          12. McCormick WE et al: Surgery for thoracic disc disease. Complication avoidance: overview and management. Neurosurg Focus. 9(4):e13, 2000
                          13. Vollmer DG et al: Transthoracic approaches to thoracic disc herniations. Neurosurg Focus. 9(4):e8, 2000