Neurochirurgische Praxis, Zeppelinstr. 24, 61352, Bad Homburg, Germany.
Eur Spine J. 2020 Feb;29(Suppl 1):39-46. doi: 10.1007/s00586-019-06212-w. Epub 2019 Nov 16.
Surgical treatment failures or strategies for the reoperation of residual thoracic disc herniations are sparsely discussed. We investigated factors that led to incomplete disc removal and recommend reoperation strategies.
As a referral centre for thoracic disc disease, we reviewed retrospectively the clinical records and imaging studies before and after the treatment of patients who were sent to us for revision surgery for thoracic disc herniation from 2013 to 2018.
A total of 456 patients were treated from 2013 to 2018 at our institution. Twenty-one patients had undergone previously thoracic discectomy at an outside facility and harboured residual, incompletely excised and symptomatic herniated thoracic discs. In 12 patients (57%), the initial symptoms that led to their primary operation were improved after the first surgery, but recurred after a mean of 2.8 years. In seven patients (33%) they remained stable, and in two cases they were worse. All patients were treated via all dorsal approaches. In all 21 cases, the initial excision was incomplete regarding medullar decompression. All of the discs were removed completely in a single revision procedure. After mean follow-up of 24 months (range 12-57 months), clinical neurological improvement was demonstrated in seven patients, while three patients suffered a worsening and 11 patients remained stable.
Our data suggest that pure dorsal decompression provides a short relief of the symptoms caused by spinal cord compression. Progressive myelopathy (probably due to mechanical and vascular deficits) and scar formation may cause worsening of symptoms. These slides can be retrieved under Electronic Supplementary Material.
对于胸椎间盘突出症手术治疗失败或再次手术的策略，相关讨论较少。我们研究了导致椎间盘切除不彻底的因素，并推荐了再次手术的策略。
作为胸椎间盘疾病的转诊中心，我们回顾性分析了 2013 年至 2018 年期间，因胸椎间盘突出症在我院行翻修手术的患者的临床记录和治疗前后的影像学资料。这些患者均来自其他医疗机构的初次手术治疗失败。
在我们机构，2013 年至 2018 年共治疗了 456 例患者。21 例患者曾在其他医疗机构行胸椎间盘切除术，术后残留有未完全切除且症状性胸椎间盘突出。12 例（57%）患者初次手术的初始症状改善，但在平均 2.8 年后复发。7 例（33%）患者病情稳定，2 例患者病情恶化。所有患者均采用所有后路入路治疗。21 例患者初次手术时在脊髓减压方面均不彻底，在单次翻修手术中均完全切除了所有椎间盘。在平均 24 个月（12-57 个月）的随访中，7 例患者的临床神经功能得到改善，3 例患者病情恶化，11 例患者病情稳定。
我们的数据表明，单纯的后路减压可暂时缓解脊髓压迫引起的症状。进行性脊髓病（可能是由于机械和血管缺陷）和瘢痕形成可能导致症状恶化。这些幻灯片可在电子补充材料中查看。
