Abstract
Object
Giant thoracic discs (occupying more than 40% of the spinal canal) are a difficult surgical pathology. They are increasingly being recognized as or particular subset of thoracic disc pathology. It has been recommended that an aggressive surgical approach of open 2 level verteberectomy and instruments should be utilized.21 However Retropleural thoracotomy provides the shortest direct route to the anterior thoracic spine and avoids pleural cavity entry making it an ideal if infrequently used approach to access ventral thoracic and thoracolumbar spine abnormalities. We present a detailed description of our experience utilising this approach, for the treatment of Giant Thoracic discs without the need for vertebrectomy or instrumentation
Methods
A prospective cohort of patients with Giant thoracic discs operated on utilizing the mini open retropleural thoracotomy technique was used, intra-operative and post-operative complications and length of post-op stay. Functional outcome and pain scores, were also prospectively recorded using SF-36, Oswestry Disability Index (ODI), and visual analogue pain scores (VAS).
Results
17 patients underwent a retropleural thoracotomy for Giant thoracic disc between 2001 and 2010. There were 8 male and 9 female patients with a median age of 50 years (range 35 – 70). The surgical level was T8/9 (58%) followed by T10/11 (33%) and finally T11/12 (8%). 1 patient had redo surgery following a failed primary discectomy at another institution. The mean post-operative length of stay was 12.8 days Intra-operative complications included 5 pleural tears during the approach. Chest drain was placed post-op in one patient. The tears were primarily repaired and the approach did not have to be abandoned. 2 patients had an intra-operative CSF leak (1 had intradural disc erosion). Post-operative complications included 1 pleural effusion, 1 patient had pneumonia and a PE, 1 patient died from an unrelated respiratory tract infection of the lung (opposite to the side of the approach) 40 days after surgery.
Conclusion
Large calcified thoracic disc herniations can be a very challenging pathology. The retropleural transthoracic approach can be employed safely in this setting with acceptable morbidity for the patient.
