Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany; Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany; Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA.
Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany.
World Neurosurg. 2022 Sep;165:154-158. doi: 10.1016/j.wneu.2022.06.097. Epub 2022 Jun 26.
Giant thoracic disk herniations are calcified hernias that fill >40% of the spinal canal and result in myelopathy with associated neurologic symptoms. This is a fairly rare abnormality that requires surgical treatment. Currently, there is no unambiguous opinion about the surgical approach to the treatment for this pathology. It is believed that the most effective method is the anterior approach (minithoracotomy or thoracoscopic approach), which reduces the risks of spinal cord injury but is associated with the risks of damage to the lungs, pleura, and major vessels. A giant thoracic disk herniation is also quite large.
We describe the case of a 60-year-old female patient with a giant thoracic disk herniation. Complete removal of the hernia through a minimally invasive dorsal approach was performed, followed by stabilization. In this case, we used 3-dimensional planning with the help of Surgical Theater, as well as intraoperative neuromonitoring. We also used the ZEISS QEVO, a microinspection tool to aid in resection.
No complications have been registered after the surgery. In this case, surgery resulted in a curative treatment outcome for the patient.
The minimally invasive dorsal approach in the surgery of giant thoracic herniated disks can be successfully used in neurosurgical practice. With this approach, it may be possible to avoid dorsal stabilization, but this requires additional research.
巨大的胸椎间盘突出是指钙化的椎间盘疝出，占据椎管的 40%以上，导致脊髓病和相关的神经症状。这是一种相当罕见的异常情况，需要手术治疗。目前，对于这种病理的治疗方法还没有明确的意见。人们认为最有效的方法是前路（小开胸或胸腔镜），它降低了脊髓损伤的风险，但也存在肺部、胸膜和大血管损伤的风险。巨大的胸椎间盘突出也很大。
我们描述了一位 60 岁女性巨大胸椎间盘突出症患者的病例。通过微创的后路完全切除了疝出物，然后进行了稳定。在这种情况下，我们使用了 Surgical Theater 的 3 维规划以及术中神经监测。我们还使用了 ZEISS QEVO 微型检查工具来辅助切除。
手术后没有出现并发症。在这种情况下，手术为患者带来了治愈性的治疗效果。
微创后路在巨大胸椎间盘突出症的手术中可以成功应用于神经外科实践。通过这种方法，可能可以避免后路稳定，但这需要进一步的研究。
