Anterolateral Approach for Central Thoracic Disc Prolapse-Surgical Strategies Used to Tackle Differing Operative Findings: 3-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2019 Jan;16(1):E5-E6

Department of Neurosurgery, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK.

Thoracic disc prolapses causing cord compression can be challenging. For compressive central disc protrusions, a posterior approach is not suitable due to an unacceptable level of cord manipulation. An anterolateral transthoracic approach provides direct access to the disc prolapse allowing for decompression without disturbing the spinal cord. In this video, we describe 2 cases of thoracic myelopathy from a compressive central thoracic disc prolapse. In both cases, informed consent was obtained. Despite similar radiological appearances of heavy calcification, intraoperatively significant differences can be encountered. We demonstrate different surgical strategies depending on the consistency of the disc and the adherence to the thecal sac. With adequate exposure and detachment from adjacent vertebral bodies, soft discs can be, in most instances, separated from the theca with minimal cord manipulation. On the other hand, largely calcified discs often present a significantly greater challenge and require thinning the disc capsule before removal. In cases with significant adherence to dura, in order to prevent cord injury or cerebrospinal fluid leak a thinned shell can be left, providing total detachment from adjacent vertebrae can be achieved. Postoperatively, the first patient, with a significantly calcified disc, developed a transient left leg weakness which recovered by 3-month follow-up. This video outlines the anatomical considerations and operative steps for a transthoracic approach to a central disc prolapse, whilst demonstrating that computed tomography appearances are not always indicative of potential operative difficulties.

Download full-text PDF

Source
http://dx.doi.org/10.1093/ons/opy063DOI Listing
January 2019
10 Reads

Publication Analysis

Top Keywords

disc prolapse
12
thoracic disc
12
disc
9
central disc
8
compressive central
8
detachment adjacent
8
transthoracic approach
8
cord manipulation
8
approach central
8
central thoracic
8
cord
5
dura order
4
differences encountered
4
weakness recovered
4
encountered demonstrate
4
strategies depending
4
depending consistency
4
consistency disc
4
disc adherence
4
providing total
4

Similar Publications