Department of Orthopaedic Surgery, University of California, 500 Parnassus Avenue, MU 320W, San Francisco, CA, 94143-0728, USA.
Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Neurosurg Rev. 2019 Dec;42(4):885-894. doi: 10.1007/s10143-018-01064-2. Epub 2019 Jan 8.
Although symptomatic thoracic disk herniation (TDH) is relatively rare, its treatment is quite difficult. Our aim is to present the outcomes and complications in patients with thoracic disk herniation treated with minimally invasive lateral transthoracic approach (LTTA). Fifty-nine consecutive patients with 69 symptomatic disk herniations that underwent minimally invasive LTTA to treat TDH between 2007 and 2016 were enrolled. Medical records were reviewed retrospectively. The numbers of TDH were as follows: 41 central, 10 paracentral, and 18 both central and paracentral. The number of calcified disk herniations was found to be 32. No patient developed neurological deficit. Postoperative neurological improvement occurred in 39 (90.7%) of 43 patients with myelopathy. Preoperative VAS scores, ODI scores, and SF-36 scores improved at the follow-up, respectively. Mean blood loss, hospitalization period, and follow-up period were found to be 391.2 mL, 4.7 days, and 60 months; respectively. The following complications were observed: dural tear (five patients), intercostal neuralgia (three patients), rib fracture (one patient), pleural effusion requiring chest tube (two patients), hydropneumothorax requiring chest tube (one patient), small pneumothorax (one patient), atelectasis (one patient), pulmonary embolism (one patient), and pneumonia (one patient). Minimally invasive LTTA not only minimizes the manipulation of the thecal sac decreasing the risk for neurological injury compared to traditional posterior methods but also significantly decreases the pulmonary complications associated with traditional open procedures. Based on the authors' experience, anterior approach should be preferred especially in calcified central disk herniations regardless of surgeon's experience.
尽管有症状的胸椎间盘突出症（TDH）相对较少见，但治疗却相当困难。我们的目的是展示采用微创侧入胸前路（LTTA）治疗胸椎间盘突出症的患者的结果和并发症。2007 年至 2016 年间，我们共收治了 59 例 69 个有症状椎间盘突出症的连续患者，这些患者均采用微创 LTTA 治疗 TDH。回顾性地审查了病历。TDH 的数量如下：41 个中央型，10 个旁中央型，18 个中央型和旁中央型。发现 32 个椎间盘钙化。没有患者发生神经功能缺损。39 例（90.7％）脊髓病患者术后神经功能改善。术前 VAS 评分、ODI 评分和 SF-36 评分在随访时均得到改善。平均失血量、住院时间和随访时间分别为 391.2ml、4.7 天和 60 个月。观察到以下并发症：硬脊膜撕裂（5 例）、肋间神经痛（3 例）、肋骨骨折（1 例）、需要胸腔引流的胸腔积液（2 例）、需要胸腔引流的液气胸（1 例）、气胸（1 例）、肺不张（1 例）、肺栓塞（1 例）和肺炎（1 例）。微创 LTTA 不仅比传统后路方法对脊髓的操作最小化，降低了神经损伤的风险，而且还显著降低了与传统开放手术相关的肺部并发症。根据作者的经验，无论外科医生的经验如何，前入路都应优先考虑，尤其是在钙化的中央型椎间盘突出症中。
