Trans-thoracic versus retropleural approach for symptomatic thoracic disc herniations: comparative analysis of 94 consecutive cases.

Autor: Soda C; Department of Neurosurgery, Verona Borgo Trento Hospital, Verona, Italy., Faccioli F; Department of Neurosurgery, Verona Borgo Trento Hospital, Verona, Italy., Marchesini N; Department of Neurosurgery, Verona Borgo Trento Hospital, University of Verona, Verona, Italy., Ricci UM; Department of Neurosurgery, Verona Borgo Trento Hospital, Verona, Italy., Brollo M; Department of Neurosurgery, Mestre Hospital, Mestre, Italy., Annicchiarico L; Department of Neurosurgery, Trento Hospital, Trento, Italy., Benato C; Department of Thoracic Surgery, Borgo Trento Hospital, Verona, Italy., Tomasi I; Department of Emergency General Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK., Pinna GP; Department of Neurosurgery, Verona Borgo Trento Hospital, Verona, Italy., Teli M; Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK.
Jazyk: angličtina
Zdroj: British journal of neurosurgery [Br J Neurosurg] 2021 Apr; Vol. 35 (2), pp. 195-202. Date of Electronic Publication: 2020 Jun 19.
DOI: 10.1080/02688697.2020.1779660
Abstrakt: Purpose: The authors illustrate their results in the surgical treatment of symptomatic thoracic disc herniations (TDHs) by comparing the traditional open to the less invasive retropleural lateral approaches.
Methods: Retrospective review of 94 consecutive cases treated at a single Institution between 1988 and 2014. Fifty-two patients were males, 42 females, mean age was 53.9 years. Mean follow-up was 46.9 months (12-79 months). 33 patients were diagnosed with a giant thoracic disc herniation (GTDH). Upon admission, the most common symptoms were: motor impairment (91.4%, n  = 86), neuropathic radicular pain with VAS > 4 (50%), bladder and bowel dysfunction (57.4% and 41.4% respectively) and sensory disturbances (29.7%). The surgical approach was based upon level, laterality and presence or absence of calcified lesions.
Results: Decompression was performed in 7 cases via a thoraco-laparo-phrenotomy and in 87 cases via an antero-lateral thoracotomy. Out of the latter cases, 49 (56%) were trans-thoracic trans-pleural approaches (TTA) and 38 (44%) were less invasive retropleural approaches (MIRA). At follow-up, there were 59.5% neurologically intact patients according to the McCormick Scale, while 64.8% and 67% had no bladder or bowel dysfunction respectively. Complications occurred in 24 patients (25.5%). Pulmonary complications were the commonest (12.7%) with pleural effusion being significantly more common in patients treated with TTA compared to MIRA (20% vs 5.2%: X 2 4.13 P:0.042). Severe post-operative neuralgia (VAS 7-10) was also significantly more frequent in the TTA group (22.4% vs 2.6% X 2 7.07 p 0.0078).
Conclusions: MIRA is a safe and effective technique to obtain adequate TDH decompression and is associated with lower morbidity compared to TTA.
Databáze: MEDLINE
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