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... 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 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Operative Neurosurgery Oxford University Press

Anterolateral Approach for Central Thoracic Disc Prolapse—Surgical Strategies Used to Tackle Differing Operative Findings: 3-Dimensional Operative Video

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Publisher
Congress of Neurological Surgeons
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
2332-4252
eISSN
2332-4260
D.O.I.
10.1093/ons/opy063
Publisher site
See Article on Publisher Site

Abstract

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

Journal

Operative NeurosurgeryOxford University Press

Published: Apr 2, 2018

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