Abstract
ABSTRACT Objective To describe the surgical results of a prospective series of five patients operated according to an approach indication protocol. Methods: Patients were classified according to surgical risk: Group A (high risk) or B (low risk) and subsequently into subgroups according to characteristics of the herniation and ultimately the surgical approach was defined: A.1) calcified central herniations - thoracoscopy; A.2) soft lateral herniations - posterolateral approach; A.3) centrolateral herniations - partial calcification in lateral position - posterolateral approach; higher density central calcification - thoracoscopy; B.1) central or centrolateral calcified herniations - thoracotomy or thoracoscopy; B.2) soft lateral herniations - posterolateral approach. Results: The duration of symptoms ranged from 2 months to 3 years; the age bracket was from 37 to 58 years; sex distribution was 3 female and 2 male patients and the length of hospital stay ranged from 2 to 20 days. The most affected level was T11/12. A patient classified as Group A.3 underwent posterolateral approach. The remaining patients were Group B.1, 3 submitted to thoracotomy and 1 to thoracoscopy. The herniation removal was completed in 5 cases; 3 patients improved and 2 remained stable. The morbidity and the recovery time were higher in patients who underwent anterolateral approaches. Conclusions: Classify patients according to surgical risk and the anatomical characteristics of disc herniation allows for complete decompression, minimizing morbidity and mortality.
Highlights
The first reports of thoracic disc herniation were published by Key[1] in 1838 and by Middleton and Teacher[2] in 1911 and the first review of surgical cases was published in 1936 by Hawk.[3]
Patients were classified according to surgical risk: Group A or B and subsequently into subgroups according to characteristics of the herniation and the surgical approach was defined: A.1) calcified central herniations - thoracoscopy; A.2) soft lateral herniations – posterolateral approach; A.3) centrolateral herniations - partial calcification in lateral position – posterolateral approach; higher density central calcification - thoracoscopy; B.1) central or centrolateral calcified herniations - thoracotomy or thoracoscopy; B.2) soft lateral herniations – posterolateral approach
Classify patients according to surgical risk and the anatomical characteristics of disc herniation allows for complete decompression, minimizing morbidity and mortality
Summary
The first reports of thoracic disc herniation were published by Key[1] in 1838 and by Middleton and Teacher[2] in 1911 and the first review of surgical cases was published in 1936 by Hawk.[3] Since that time, several access approaches have been described, but there is still no “gold standard” for the treatment of this pathology. The incidence of thoracic disc herniation with neurological deficit is 1/1,000,000,4,5 though incidental magnetic resonance findings are 10-20%.6,7. Surgical indications for this pathology are rare, corresponding to between 0.15 and 4% of disc herniation surgeries.[8]. The presence of intradiscal calcifications is characteristic, occurring in 60% of cases, and is a critical factor in determining the best surgical access approach.[10,11,12] Approximately 75% of thoracic disc hernias are located below T8, primarily at T11-T12.13
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