Abstract Thoracic disc prolapses causing cord compression can be challenging. For compressive central disc protrusions, a posterior approach is not suitable due to an unacceptable level of cord manipulation. An anterolateral transthoracic approach provides direct access to the disc prolapse allowing for decompression without disturbing the spinal cord. In this video, we describe 2 cases of thoracic myelopathy from a compressive central thoracic disc prolapse. In both cases, informed consent was obtained. Despite similar radiological appearances of heavy calcification, intraoperatively significant differences can be encountered. We demonstrate different surgical strategies depending on the consistency of the disc and the adherence to the thecal sac. With adequate exposure and detachment from adjacent vertebral bodies, soft discs can be, in most instances, separated from the theca with minimal cord manipulation. On the other hand, largely calcified discs often present a significantly greater challenge and require thinning the disc capsule before removal. In cases with significant adherence to dura, in order to prevent cord injury or cerebrospinal fluid leak a thinned shell can be left, providing total detachment from adjacent vertebrae can be achieved. Postoperatively, the first patient, with a significantly calcified disc, developed a transient left leg weakness which recovered by 3-month follow-up. This video outlines the anatomical considerations and operative steps for a transthoracic approach to a central disc prolapse, whilst demonstrating that computed tomography appearances are not always indicative of potential operative difficulties. Anterolateral, ventrolateral, thoracic disc, thoracotomy, image guidance, calcified disc, transthoracic approach, anterolateral approach, 3-dimensional video Disclosure The authors have no personal, financial, and institutional interest in any of the drugs, materials, or devices described in this article. View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy063 View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy063 Anterolateral Approach for Central Thoracic Disc Prolapse—Surgical Strategies Used to Tackle Differing Operative Findings: 3-Dimensional Operative Video Anterolateral Approach for Central Thoracic Disc Prolapse—Surgical Strategies Used to Tackle Differing Operative Findings: 3-Dimensional Operative Video Close COMMENTS The authors should be congratulated for presenting a quality video demonstrating trans-thoracic treatment of thoracic disk herniations. The authors successfully highlight the relevant decision-making and anatomy, key steps, and complication management for this less commonly encountered pathology. Matthew Neal Winston-Salem, North Carolina The authors provide an excellent quality video and commentary on performing anterolateral trans-thoracic discectomy for the difficult problem of thoracic disc herniations and calcified herniations. The 3-dimensional nature of the video, especially, helps the viewer to better understand the anatomic relationships. This type of approach can similarly be carried out in the same fashion using lumbar lateral tools for a minimally invasive technique. Christopher C. Gillis Vancouver, Cananda Copyright © 2018 by the Congress of Neurological Surgeons
Operative Neurosurgery – Oxford University Press
Published: Apr 2, 2018
It’s your single place to instantly
discover and read the research
that matters to you.
Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.
All for just $49/month
Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly
Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.
Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.
Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.
All the latest content is available, no embargo periods.
“Hi guys, I cannot tell you how much I love this resource. Incredible. I really believe you've hit the nail on the head with this site in regards to solving the research-purchase issue.”Daniel C.
“Whoa! It’s like Spotify but for academic articles.”@Phil_Robichaud
“I must say, @deepdyve is a fabulous solution to the independent researcher's problem of #access to #information.”@deepthiw
“My last article couldn't be possible without the platform @deepdyve that makes journal papers cheaper.”@JoseServera