European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2017 07 07() doi 10.1007/s00586-017-5192-6
To help guide treatment strategies and create insight into functional outcomes in patients with Giant herniated thoracic discs (GHTD), which are defined as occupying more than 40% of spinal canal.
Authors did a retrospective analysis of prospective cohort of 33 cases of GHTD, using clinical letters, notes, and telephonic questionnaires to determine their pre and postoperative functional status, surgical details, and complication rates. 16 males and 17 females operated between 2006 and 2014 were included in the study. A total of 23 patients underwent thoracotomy, 9 costotransversectomy, and 2 transpedicular approaches for excision of thoracic discs. Neuromonitoring was used in seven patients.
Frankel grade improved by 1 in 13 patients and by 2 in 1 patient. One patient of T11/12 GHTD with neurogenic claudication recovered completely, taking the overall improvement rate to 45.5%. It remained static in 15 patients (45.5%) and deteriorated by 1 in 3 patients (9%). By mJOA scoring too, the outcome was favorable in majority (84.4%) of patients. There were three intraoperative complications (9%), which included two incidental durotomies and one massive blood loss. Late postoperative complications were seen in 12(39%) patients. They included intercostal neuralgia, mechanical pain around costotransversectomy, progressive thoracic paraplegia due to spinal cord herniation and residual disc fragments, reactive pleural effusion, CSF fistula induced pleural effusion, and infective discitis.
Surgery for giant herniated thoracic disc has favorable outcome in majority (91%) of patients. However, significant approach-related complications are to be anticipated in patients undergoing thoracotomies, most of them being manageable. Author recommends costotransversectomy, only in paracentral discs with smaller percentage canal stenosis.