Transthoracic Discectomy for Symptomatic Thoracic Disc Herniation: 2-Dimensional Operative Video
Saadeh, Yamaan S MD; Khalsa, Siri S MD; Smith, Brandon W MD; Joseph, Jacob R MD; Khorfan, Rhami F MD; Park, Paul MD,
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
General Surgery, Saint Joseph Mercy Health System, Ann Arbor, Michigan
Correspondence: Paul Park, MD, Neurosurgery Spine Program, University of Michigan, Department of Neurosurgery, Ann Arbor, MI 48109. E-mail: [email protected]
Abstract
Thoracic disc herniations are an infrequent occurrence, but can be a cause of significant myelopathy. Diagnosis typically requires a high clinical suspicion that is confirmed with appropriate imaging. Classically, the transthoracic approach for discectomy is the treatment of choice for symptomatic cases. This video concerns a 48-yr-old woman who presented with worsening mid-back pain and progressive gait difficulty. Her examination was significant for proximal lower extremity muscle weakness, difficulty with tandem gait, and urinary incontinence. Imaging demonstrated a large T7-8 disc herniation causing severe spinal cord compression. The patient underwent T7-8 transthoracic discectomy and interbody fusion. She tolerated the procedure well without complication, and postoperative imaging demonstrated decompression of her spinal cord. On follow-up, she had improved mid-back pain, strength, and ambulatory function.
The patient consented to the recording of this surgical video for potential publication.
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Disclosures
The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
COMMENT
In this video, the authors provide a clear and concise description of how to perform a transthoracic discectomy for a patient with thoracic myelopathy. The unique anatomy and rare nature of this operation make this a very difficult procedure. The authors clearly outline the indications, positioning, and steps of the discectomy making this a useful reference for practicing spine surgeons.
Ajit Krishnaney
Cleveland, Ohio
Keywords:Transthoracic discectomy; Thoracic disc herniation; Thoracic spinal cord compression; Anterior approach; Thoracotomy
Copyright © 2019 by the Congress of Neurological Surgeons
