Thoracic disc herniation: case series and surgical approach protocol

Abstract

Objective. Describe the surgical outcome of a case series of 11 cases submitted to surgical treatment based on a protocol developed to suggest the best approach to treat thoracic disc displacement. Method. Patients were classified based on surgical risk: Group A (high surgical risk) or B (low surgical risk); thereafter, subgroups were defined based on herniation features: calcification, position (central or lateral). The surgical approach was used according to these two characteristics:  A.1) Central Calcified displacement – Thoracoscopic approach; A.2) Lateral soft herniation – posterolateral approach; A.3) Lateral calcified displacement – posterolateral approach; B.1) Central displacement or calcified centro-lateral displacement – thoracotomy or thoracoscopic approach; B.2) Soft lateral herniation – posterolateral approach. Results. 11 patients have been treated with this protocol (6 males). Three patients were Frankel C and eight Frankel D on admission. The average age was 44.27±14.08 years. Just one patient had non-calcified displacement, 3 patients had lateral displacement and 8 central displacements. The average time from symptoms to surgery was 9±10.81 months. 8 patients had improved after surgery. 3 patients (27%) presented no improvement after surgery. No new neurological deficit was observed.  No clinical complications occurred, although one patient had partial displacement removed and one patient needed additional surgery to remove residual displacement. Conclusions. This protocol can be used to plan the approach in thoracic disc displacement especially based on anatomical features of the herniated disc.