Management of Giant Thoracic Disc Herniation by Thoracoscopic Approach: Experience of 53 Cases
Résumé
BACKGROUND: Giant thoracic disc herniation (gTDH) is a rare condition. It is defined by
a herniation that occupies at least 40% of the thoracic spinal canal and is usually calcified.
Several surgical techniques have been described to date but this surgery remains a technically
difficult procedure.
OBJECTIVE: To report the long-term outcomeof 53 patients with myelopathy due to gTDH
who were operated on by a thoracoscopic approach. The technical details of the preoperative
assessment and the surgical procedure are presented.
METHOD: We present a retrospective study of a database of 53 patients operated for
symptomatic gTDH by a thoracoscopic approach. The following clinical parameters were
assessed initially and used during follow-up: Frankel grade and JOA score adapted to the
thoracic spine (mJOA), pain in the lower limbs and limitation of the walking perimeter to
less than 500 meters. The quality of spinal cord decompression was assessed postoperatively
by magnet resonance imaging (MRI).
RESULTS: The mean follow-up was 78.1 mo (SD 49.4). At the last follow-up visit, clinical
examination showed a mean improvement of 0.91 Frankel grade (P < .001) and 2.56 mJOA
score respectively (P < .001). Lower limb pain and walking perimeter were also improved.
Postoperative MRI revealed that the resection was complete in 35 cases, subtotal in 13 cases,
and incomplete in 5 cases.
CONCLUSION: gTDH is a condition that often evolves favorably after surgery. The thoracoscopic
approach is a feasible alternative technique.
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