THORACIC DISC HERNIATION: CASE SERIES AND PROTOCOL FOR SURGICAL APPROACHES

HÉRNIA DE DISCO TORÁCICO: SÉRIE DE CASOS E PROTOCOLO DE VIA DE ACESSO CIRÚRGICO

HERNIA DE DISCO TORÁCICO: SERIE DE CASOS Y PROTOCOLO DE ACCESO QUIRÚRGICO

ABSTRACT

Objective

To describe the surgical results of a prospective series of five patients operated according to an approach indication protocol.

Methods:

Patients were classified according to surgical risk: Group A (high risk) or B (low risk) and subsequently into subgroups according to characteristics of the herniation and ultimately the surgical approach was defined: A.1) calcified central herniations - thoracoscopy; A.2) soft lateral herniations - posterolateral approach; A.3) centrolateral herniations - partial calcification in lateral position - posterolateral approach; higher density central calcification - thoracoscopy; B.1) central or centrolateral calcified herniations - thoracotomy or thoracoscopy; B.2) soft lateral herniations - posterolateral approach.

Results:

The duration of symptoms ranged from 2 months to 3 years; the age bracket was from 37 to 58 years; sex distribution was 3 female and 2 male patients and the length of hospital stay ranged from 2 to 20 days. The most affected level was T11/12. A patient classified as Group A.3 underwent posterolateral approach. The remaining patients were Group B.1, 3 submitted to thoracotomy and 1 to thoracoscopy. The herniation removal was completed in 5 cases; 3 patients improved and 2 remained stable. The morbidity and the recovery time were higher in patients who underwent anterolateral approaches.

Conclusions:

Classify patients according to surgical risk and the anatomical characteristics of disc herniation allows for complete decompression, minimizing morbidity and mortality.

Keywords:
Intervertebral disk/surgery; Thorax; Decompression, surgical; Intervertebral disc displacement; Risk groups; Morbidity; Laminectomy/methods; Thoracotomy; Thoracoscopy.