Abstract
Aim
A retrospective review of the management of giant thoracic discs and report of their outcomes.
Method
Giant thoracic disc have been defined as disc compressing more than 60% of the canal diameter. Although discectomy may lead to improvement of clinical symptoms it can be complicated by approach related morbidity especially when discs are calcified. Between 2007 and 2010 there were a total of 7 patients treated with a giant thoracic disc. A retrospective review of demographic data, symptoms, details of surgery, pre and post operative radiology, pre and postoperative Nurick scores, ODI and pain score, length of stay, complications and follow-up data were collected in all patients.
Results
The average duration of symptoms was 8.5 months with a mean age of 58 years. Six patients (85%) presented with myelopathy, difficulty in walking and motor weakness. Discs were located at T5/6-2, T7/8-1, T8/9-1, T9/10-2 and T10/11-1 levels. Four (58%) discs were calcified and 3 (42%) were adherent to the dura. The average disc encroachment into the spinal canal was 81% (range: 67%-92%). All patients had a right mini thoracotomy and none of the patients were instrumented. All patients were followed up for a minimal of 24 months (range: 18 to 36 months). Improved Nurick, pain and ODI scores were seen in all patients. Average duration of stay was 4 days (range: 3-9 days). Only one patient had a dural leak and pseudo-meningocele with a calcified adherent disc. Successful dural reconstruction was done in 2 more patients with calcified disc. Two patients had post-operative thoracotomy pain needing pain management. No clinical deterioration was seen in any of the patients and all patients improved in their motor power and myelopathy.
Conclusions
Mini-thoracotomy for treatment of giant thoracic disc herniations is associated with improvement of motor power and myelopathic symptoms with an acceptable rate of complications. Experienced team and careful surgical planning leads to success. For a single level surgery no instrumentation is required as suggested in most series.
