Thoracic disc herniation causing myelopathy: Our experience using transthoracic approach

Abstract

The authors have reported six cases of thoracal discus hernia in five patients. All the patients have recently been examined in neurosurgery institutions. They had different degrees of neurological deficit, with tendency to aggravation. The same procedure has been applying: thoracotomy, large decompression of neural structures, and obligatory spondylodesis with the patient?s own rib. In three cases a full recovery has been achieved, a partial recovery in other two. Complete and definitive paraplegia developed in one patient. The degree of the neurological recovery was between one and two points by Frankel scale. Better results have been obtained where symptoms were present for a short period of time, and myelopathic signs were mild. The follow up period was between 43 and 68 months. Three of the patients have been returned to their professional work. In one patient, three years after the first surgery, there has been diagnosed another discus hernia, one level below. She was treated with the same surgical technique as described, for the second time. Multilevel symptomatic thoracic disc herniations are extremely rare. Although a small series, it is clearly pointed the need to think of a discus hernia, and its early diagnostics and adequate surgical treatment. The first experience with the operative technique described, demonstrated that this procedure is good and justified.