Stillerman C B, Chen T C, Day J D, Couldwell W T, Weiss M H
Department of Neurosurgery, University of Southern California School of Medicine, Los Angeles, USA.
J Neurosurg. 1995 Dec;83(6):971-6. doi: 10.3171/jns.1995.83.6.0971.
A number of operative techniques have been described for the treatment of herniated thoracic discs. The transfacet pedicle-sparing approach allows for complete disc removal with limited spinal column disruption and soft-tissue dissection. Fifteen cadaveric spinal columns were used for evaluation of exposure, development of thoracic microdiscectomy instrumentation, and establishment of morphometric measurements. This approach was used to remove eight thoracic discs in six patients. Levels of herniation ranged from T-7 through T-11. Preoperatively, all patients had moderate to severe axial pain, and three (50%) of the six had radicular pain. Myelopathy was present in four (67%) of the six patients. Through a 4-cm opening, the ipsilateral paraspinal muscles were reflected, and a partial facetectomy was performed. The disc was then removed using specially designed microscopic instrumentation. Postoperatively, the radiculopathy resolved in all patients. Axial pain and myelopathy were completely resolved or significantly improved in all patients. The minimal amount of bone resection and muscle dissection involved in the operation allows for: 1) decreased operative time and blood loss; 2) diminished perioperative pain; 3) shorter hospitalization time and faster return to premorbid activity; 4) avoidance of closed chest tube drainage; and 5) preservation of the integrity of the facet-pedicle complex, with potential for improvement in outcome related to axial pain. This technique appears best suited for the removal of all centrolateral discs, although it has been used successfully for treating a disc occupying nearly the entire ventral canal. The initial experience suggests that this approach may be used to safely remove appropriately selected thoracic disc herniations with good results.
已经描述了多种用于治疗胸椎间盘突出症的手术技术。经小关节保留椎弓根入路可在有限的脊柱破坏和软组织剥离的情况下完全切除椎间盘。使用15具尸体脊柱来评估暴露情况、开发胸椎显微椎间盘切除术器械以及建立形态学测量。该方法用于6例患者中切除8个胸椎间盘。突出节段范围从T-7至T-11。术前，所有患者均有中度至重度轴向疼痛，6例中有3例（50%）有神经根性疼痛。6例患者中有4例（67%）存在脊髓病。通过4厘米的切口，将同侧椎旁肌牵开，并进行部分小关节切除术。然后使用专门设计的显微器械切除椎间盘。术后，所有患者的神经根病均得到缓解。所有患者的轴向疼痛和脊髓病均完全缓解或明显改善。手术中涉及的骨切除和肌肉剥离量最小，可实现：1）减少手术时间和失血量；2）减轻围手术期疼痛；3）缩短住院时间并更快恢复至病前活动水平；4）避免闭式胸腔引流；5）保留小关节-椎弓根复合体的完整性，有可能改善与轴向疼痛相关的预后。尽管该技术已成功用于治疗几乎占据整个椎管腹侧的椎间盘，但它似乎最适合于切除所有中央外侧椎间盘。初步经验表明，该方法可用于安全地切除适当选择的胸椎间盘突出症，效果良好。
