Abstract
PurposeSurgical 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.MethodsAs 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.ResultsA 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.ConclusionOur 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.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
The incidence of surgically treated thoracic herniations in the USA is approximated to be 1:116,338 [1]
Adequate invasive techniques and instruments have been developed for thoracic and lumbar approaches popularizing the principle of approaching the thoracic spine anterolaterally
Few articles have been published in the literature dealing with strategies for the reoperation of residual or recurrent thoracic disc herniations [10,11,12,13]
Summary
The incidence of surgically treated thoracic herniations in the USA is approximated to be 1:116,338 [1]. Disc herniations at the thoracic spine can be difficult to remove. While some researchers advocate to consider the surgeons experience [2, 3], the scientific question for the best treatment strategy thereby remains unanswered. Laminectomy was abandoned during the last 30 years— with exceptions [4, 5]—and anterolateral transthoracic approaches gained popularity [4, 6,7,8,9]. Adequate invasive techniques and instruments have been developed for thoracic and lumbar approaches popularizing the principle of approaching the thoracic spine anterolaterally. Few articles have been published in the literature dealing with strategies for the reoperation of residual or recurrent thoracic disc herniations [10,11,12,13]
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