The transdural approach for thoracic disc herniations: a technical note.
Surgery for thoracic disc herniations is still challenging, and the disc excision via a posterior laminectomy is considered risky. A variety of dorsolateral and ventral approaches have been developed. However, the lateral extracavitary and transthoracic approach require extensive surgical exposure. Therefore, we adopted a posterior transdural approach for direct visualization without entry into the thoracic cavity. Three cases that illustrate this procedure are reported here with the preoperative findings, radiological findings and surgical techniques used. After the laminectomy, at the involved level, the dorsal dura was opened with a longitudinal paramedian incision. The cerebrospinal fluid was drained to gain more operating space. After sectioning of the dentate ligaments, gentle retraction was applied to the spinal cord. Between the rootlets above and below, the ventral dural bulging was clearly observed. A small paramedian dural incision was made over the disc space and the protruded disc fragment was removed. Neurological symptoms were improved, and no surgery-related complication was encountered. The posterior transdural approach may offer an alternative surgical option for selected patients with thoracic paracentral soft discs, while limiting the morbidity associated with the exposure.
Moon
Sung-Jun
SJ
Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, 671 Jebongno, Dong-Ku, Kwangju, 501-757, South Korea.
Lee
Jung-Kil
JK
Jang
Jae-Won
JW
Hur
Hyuk
H
Lee
Jae-Hyun
JH
Kim
Soo-Han
SH
D000328:Adult; D000368:Aged; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome