Removal of the intervertebral thoracic disc hernia under intraoperative neuromonitoring: case series
https://doi.org/10.14531/ss2019.2.18-26
Abstract
Objective. To analyze the results of the removal of thoracic intervertebral disc hernia through posterior surgical approach using intraoperative neuromonitoring.
Material and Methods. A total of 14 patients aged 43–64 years (M = 53.9) were operated on through posterior approach for symptomatic hernia of the thoracic intervertebral discs, with myelopathy (isolated or in combination with radiculopathy) in seven cases, and with isolated radiculopathy in another seven cases. Hernia were ossified in 6 cases. Operations were performed using intraoperative neuromonitoring. In 11 cases, unilateral or bilateral laminectomy and facetectomy were performed to remove a hernia; in three cases – laminectomy with resection of the facet joints and pedicles (in two of them, with ossified large and giant hernias, radiculotomy was performed to mobilize the dural sac).
Results. The long-term clinical results of surgical interventions were evaluated 1–4 years after the surgery using VAS-10, ODI, and Frankel scales. VAS scores decreased by 2–6 points In 11 patients, and remained at the same low level characterized by mild pain (1–2 points) in three patients. In patients with myelopathy, the Frankel scale showed a positive trend in six out of seven cases. Two patients showed an increase in neurological deficit in the postoperative period. In one case, neurological disorders regressed within a short period of time, in the other one, they became permanent. Damage to the dura mater was observed in two cases.
Conclusion. Intraoperative neuromonitoring allows the surgeon to act more actively and confidently in the area of disco-medullar conflict and thereby avoid excessive expansion of surgical approach without compromising the surgical result. A small number of observations does not allow making evidence-based conclusion.
About the Authors
S. P. Markin
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Sergey Petrovich Markin, MD, PhD, neurosurgeon in Neurosurgical Department No. 2, Frunze str., 17, Novosibirsk, 630091, Russia
Russian Federation
Sergey Petrovich Markin, MD, PhD, neurosurgeon in Neurosurgical Department No. 2, Frunze str., 17, Novosibirsk, 630091, Russia
A. E. Simonovich
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Alexandr Evgenyevich Simonovich, DMSc, Prof., chief researcher of the Department of research organizing, Frunze str., 17, Novosibirsk, 630091, Russia
Russian Federation
Alexandr Evgenyevich Simonovich, DMSc, Prof., chief researcher of the Department of research organizing, Frunze str., 17, Novosibirsk, 630091, Russia
V. S. Klimov
Federal Neurosurgical Center; Novosibirsk State Medical University
Russian Federation
Russian Federation
Vladimir Sergeyevich Klimov, MD, PhD, Head of Neurosurgical Department No. 2, Nemirovicha-Danchenko str., 132/1, Novosibirsk, 630087, Russia;
Аssistant Professor Department of Neurosurgery, Krasny pr., 52, Novosibirsk, 630091, Russia
A. V. Evsyukov
Federal Neurosurgical Center
Russian Federation
Aleksey Vladimirovich Evsyukov, MD, PhD, neurosurgeon in Neurosurgical Department No. 2, Nemirovicha-Danchenko str., 132/1, 630048, Novosibirsk, Russia
Russian Federation
Aleksey Vladimirovich Evsyukov, MD, PhD, neurosurgeon in Neurosurgical Department No. 2, Nemirovicha-Danchenko str., 132/1, 630048, Novosibirsk, Russia
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Review
For citations:
Markin S.P., Simonovich A.E., Klimov V.S., Evsyukov A.V. Removal of the intervertebral thoracic disc hernia under intraoperative neuromonitoring: case series. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2019;16(2):18-26. https://doi.org/10.14531/ss2019.2.18-26
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