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Is There a Place for the Posterior Approach in Cases of Acute Myelopathy on Thoracic Disc Hernia ?

Article dans une revue avec comité de lecture
Author
BRAUGE, David
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
MADKOURI, Rachid
410109 Hôpital Foch [Suresnes]
REINA, Vincent
410109 Hôpital Foch [Suresnes]
BENNIS, Saad
410109 Hôpital Foch [Suresnes]
BAUSSART, Bertrand
410109 Hôpital Foch [Suresnes]
MIREAU, Etienne
100294 Service de neurochirurgie
410109 Hôpital Foch [Suresnes]
ALDEA, Sorin
410109 Hôpital Foch [Suresnes]
GAILLARD, Stephan
410109 Hôpital Foch [Suresnes]

URI
http://hdl.handle.net/10985/18202
DOI
10.1016/j.wneu.2017.08.100
Date
2017
Journal
World Neurosurgery

Abstract

BACKGROUND: Acute myelopathy in cases of thoracic disc herniation (TDH) is an exceptional condition for which the treatment is not codified. Here we present the results of a standardized procedure in 10 patients who underwent surgery for acute myelopathy on TDH between December 2009 and December 2016. - METHODS: Our approach began with a cautious laminectomy without resection of the hernia on the day of admission. On subsequent days, a complementary thoracoscopic procedure was performed according to the patient’s neurologic recovery and the nature of the hernia (calcified or fibrous). Outcome was assessed by the Frankel score at the last consultation. - RESULTS: All patients had acute myelopathy, with Frankel score of C or worse and a TDH detected on magnetic resonance imaging occupying an average of 62.5 18.4% of the canal. This lesion was calcified in 6 cases and soft in 4 cases. The laminectomy allowed stabilization in 1 case and a neurologic improvement in 9 cases. Complementary surgery via a thoracoscopic approach was performed in the 6 cases of calcified hernia. After an average follow-up of 44.55 26.44 months, 6 patients showed complete neurologic recovery and 4 had moderate sequelae (Frankel D). - CONCLUSIONS: Laminectomy appears to allow stabilization of the neurologic situation in rare cases of acute myelopathy on TDH. The need for complementary resection of the hernia by an anterior approach should always be discussed secondarily.

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