Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Clin Neurol Neurosurg. 2024 Jan;236:108055. doi: 10.1016/j.clineuro.2023.108055. Epub 2023 Nov 19.
Thoracic disc herniations (TDH) are uncommon compared to cervical and lumbar disc herniations. Surgical treatment of TDH can be challenging due to the anatomical constraints and the high risk of morbidity due to proximity to the thoracic spinal cord. Moreover, the selection of appropriate surgical approach depends on various factors such as the size and location of disc herniation within the spinal canal, spinal level, presence or absence of calcification, degree of spinal cord compression, and familiarity with various approaches by the treating surgeon. While there is agreement that posterolateral approaches can be used to treat posterolateral and central soft disc herniation, there is a lack of consensus on the best surgical approach for central calcified and giant calcified TDH where an anterior approach is perceived as the best option. There is increasing evidence that support the safety and efficacy of posterolateral approaches even for central calcified and giant calcified TDH. This review highlights the evolution of surgical management for TDH based on the past and current literature and the author's experience at his institution.
与颈椎和腰椎间盘突出症相比，胸椎间盘突出症（TDH）并不常见。由于解剖限制以及靠近胸脊髓导致发病率高，TDH 的手术治疗具有挑战性。此外，合适的手术入路的选择取决于多种因素，例如椎管内椎间盘突出的大小和位置、脊柱水平、是否存在钙化、脊髓压迫程度以及治疗外科医生对各种入路的熟悉程度。虽然人们一致认为可以使用后外侧入路来治疗后外侧和中央软性椎间盘突出症，但对于中央钙化和巨大钙化 TDH 的最佳手术入路仍存在分歧，因为人们认为前路入路是最佳选择。越来越多的证据支持后外侧入路的安全性和有效性，即使对于中央钙化和巨大钙化 TDH 也是如此。这篇综述根据过去和当前的文献以及作者在其机构的经验，强调了 TDH 的手术治疗方法的演变。
