Reoperation for herniated thoracic discs

作者：Curtis A. Dickman, Daniel J. Rosenthal, John J. Regan · 发表于：Journal of Neurosurgery Spine · 年份：1999 · DOI：10.3171/spi.1999.91.2.0157 · 被引用次数：78 · 研究领域：Spine and Intervertebral Disc Pathology、Cervical and Thoracic Myelopathy、Spinal Dysraphism and Malformations

OBJECT: In this review the authors address the surgical strategies required to resect residual herniated thoracic discs. METHODS: Data obtained in 15 patients who had undergone prior thoracic discectomy and who harbored residual or incompletely excised symptomatic thoracic discs were reviewed retrospectively. The surgical procedures that had failed to excise the herniated discs completely included 11 posterolateral approaches, one thoracotomy, and three thoracoscopy-guided surgical procedures. Of the lesions that were incompletely resected or residual, there were 13 central calcified, two soft. 12 extradural, and three intradural discs. Indications for reoperation were often multiple in each patient and included misidentification of the level of disc disease at the initial operation (five cases), abandoning the procedure because of intraoperative spinal cord injury (three cases), inadequate visualization of the pathological entity (eight cases), migration of a soft disc fragment within the spinal canal (one case), and intradural disc extension (three cases). The symptoms at the time of reoperation included myelopathy in 13 patients and radicular pain in two patients. The mean interval before reoperation was 150 days (range 1 day-4 years). The reoperation procedures included one thoracotomy and 14 video-assisted thoracoscopic procedures performed ipsilateral (11 cases) or contralateral (four cases) to the site of the initial surgery. The herniated disc material was excised com...