title: Giant central thoracic disc herniations: surgical outcome in 17 consecutive patients treated by mini-thoracotomy.
abstract: Safe treatment of giant central thoracic disc herniations (cTDHs) remains a surgical challenge due to frequent calcifications, intradural extension and, importantly, the rare exposure of spine surgeons to these lesions. We report our 10-year experience in the management of giant cTDH by mini-thoracotomy and offer a detailed description of the technique.
  
  
  
  17 patients harboring 17 giant cTDH operated on via a mini-thoracotomy at the authors' institution between 2004 and 2014 were reviewed. All patients presented with myelopathy of varying magnitude. Mean patient age was 47 years. The mean follow-up period was 5.5 years. Median canal compromise of the cTDH was 66 %. cTDH were densely calcified in 7 (41 %), partially calcified in 6 (35 %) and soft in 4 (24 %) patients. Intradural extension of cTDH was noted in six patients (35 %). Benzels' modified myelopathy score of the Japanese Orthopedic Association was adjusted for the evaluation of thoracic myelopathy (mJOA) to assess functional outcomes.
  
  
  
  Successful removal of the offending cTDH was achieved in all patients. The overall mJOA Score improved from 7.9/13 to 11.1/13. Two patients with giant and densely calcified cTDH experienced a transient post-operative neurological decline. There was a statistically significant correlation between size of cTDH and intradural extension.
  
  
  
  Patients with myelopathy due to giant cTDH can be safely treated by the mini-thoracotomy approach. Postoperative neurological worsening and severe complications or incisional pain are rare. In contrast to complex posterior or thoracoscopic approaches, the mini-thoracotomy is technically straightforward and thus easy to learn for experienced spine surgeons.
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. roland.roelz@uniklinik-freiburg.de.
authors.forename: Roland
authors.initials: R
authors.lastname: Roelz
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Scholz
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
authors.forename: Jan-Helge
authors.initials: JH
authors.lastname: Klingler
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Scheiwe
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
authors.forename: Ronen
authors.initials: R
authors.lastname: Sircar
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hubbe
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013904:Thoracic Vertebrae / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Myelopathy; Thoracic disc herniation; Thoracic spine; Transthoracic approach