Boriani S, Biagini R, De Iure F, Rocella P, Veronesi V, Dalbuono S, Di Fiore M
1st Department of Orthopaedics, University of Bologna, Italy.
Spine (Phila Pa 1976). 1994 Nov 1;19(21):2461-6. doi: 10.1097/00007632-199411000-00018.
A double, contiguous disc herniation in the thoracic spine (T7-T8, T8-T9) in a 44-year-old man is reported. The patient complained of intermittent episodes of weakness and numbness in the lower extremities, paraesthesias radiating to the anterior and medial surfaces of the thigh and the leg (mostly on the left side), and mild sexual and urinary dysfunction.
The treatment must achieve complete spinal cord decompression, prevent further herniation, and prevent iatrogenic vascular damage to the cord. A transthoracic approach seems to offer the largest surgical view.
Twenty-six other cases of two-level thoracic disc herniation were found in the literature, only five of which were treated with a transthoracic approach.
Treatment consisted of complete disc excision (T7-T8 and T8-T9) with a right anterior transthoracic approach. Complete and safe removal of the discs required hemicorporectomy of T8 and subsequent grafting and plating. Spinal cord angiography, showing the Adamkiewicz artery originating from the left T10, was performed before surgery. Computed tomography-guided methylene blue injection in the retropleural interspace of T7-T8 was done for intraoperative level localization.
At 1 year follow-up, complete relief of neurologic symptoms was observed, as was solid interbody fusion.
In this case, a transthoracic approach was safe and effective for disc excision and cord decompression via hemicorporectomy.
报告了一名44岁男性胸椎（T7-T8、T8-T9）双节段连续椎间盘突出症。患者主诉下肢间歇性无力和麻木、感觉异常放射至大腿和小腿的前内侧表面（主要在左侧），以及轻度性功能和排尿功能障碍。
治疗必须实现脊髓完全减压，防止进一步突出，并防止对脊髓的医源性血管损伤。经胸入路似乎能提供最大的手术视野。
文献中发现了另外26例双节段胸椎椎间盘突出症病例，其中仅5例采用经胸入路治疗。
采用右前经胸入路对椎间盘（T7-T8和T8-T9）进行完全切除。完全安全地切除椎间盘需要对T8进行半椎体切除术，随后进行植骨和钢板固定。术前进行脊髓血管造影，显示Adamkiewicz动脉起源于左T10。术中在T7-T8胸膜后间隙进行计算机断层扫描引导下的亚甲蓝注射以定位节段。
随访1年时，观察到神经症状完全缓解，椎间融合牢固。
在该病例中，经胸入路通过半椎体切除术进行椎间盘切除和脊髓减压是安全有效的。
