Transthoracic disc herniation

The thoracic disc herniation is dominated by the central type and the lateral central type, and the outer type only accounts for about 10%. Although prominent in each thoracic disc, but according to statistics, chest 8 ~ 11 is more common. For patients with central and paracentralized spinal cord compression, the treatment with laminectomy is not ideal; after laminectomy, the spinal cord is resected in the spinal canal to remove the pressure in front of it, not only difficult to operate, but also suffered from spinal cord injury. Pulling and squeezing, the surgical damage is also great. In 1958, Crafoord et al reported a case of transthoracic approach, in which the prominent intervertebral disc portion was directly removed in front of the spinal cord, and the postoperative effect was good. Since then, Perot et al. reported 2 cases of transthoracic surgery in 1969. In the same year, Ransohoff and other reports reported 3 cases, all of which received good results. Mulier et al (1998) reported 7 cases of thoracic disc herniation and 324 cases in the literature. Stillerman et al (1998) used 4 surgical approaches to remove 82 prominent thoracic discs, all of which were considered to be resected by thoracotomy. Thoroughly, the treatment is good. Therefore, transthoracic approach is considered a better surgical method for thoracic disc herniation. Treatment of diseases: thoracic disc herniation Indication The central and paracentral type of thoracic disc herniation, the symptoms of spinal cord compression are obvious, confirmed by myelography or MRI, early surgery should be performed. Contraindications 1. Complete paraplegia with a course of more than half a year. 2. Patients with chronic respiratory diseases and pulmonary insufficiency. Preoperative preparation Intratracheal intubation was general anesthesia. Take the lateral position, the upper chest and the middle thoracic disc herniation take the left lateral position, because the right thoracotomy heart and large blood vessels are less affected; if the lower thoracic disc protrudes, the right lateral position is taken, because the left side is open When the chest reveals the spine, the aorta moves easier than the inferior vena cava. Surgical procedure Preoperative positioning The vertebral space was determined by the surface anatomy of the ribs. The upper and middle chest lesions can be counted down from the second rib to the position of each rib; the lower chest lesion is counted upward by the last rib. Determine the next rib of the diseased intervertebral space, follow it, and draw a line of skin incision with gentian violet. 2. surgical incision Cut the skin along the line, cut the periosteum of the rib of the diseased intervertebral space, and peel the periosteum with the rib periosteum stripper. Cut the ribs at 8 cm from the medial end of the rib and cut it together with the rib neck and head. 3. Cut the pleura Carefully protect the intercostal nerves and blood vessels, paying particular attention to retaining the large root arteries that enter the intervertebral foramen along with the intercostal nerves. Open the thorax with a retractor, and lob the lungs forward with large gauze to reveal the side of the vertebral body and the intervertebral space. 4. Exposing the disc herniation Taking the intercostal nerve into the intervertebral foramen as a sign, it should be noted that the intercostal nerve is located in the posterior superior part of the intervertebral foramen, and the intervertebral space is in the anterior and posterior aspect of the intervertebral foramen. Using the small head stripper to examine the posterior edge of the diseased intervertebral space, the disc portion that protrudes into the spinal canal can be seen to squeeze the dural sac back. At this time, if there is doubt about the protruding position, the needle can be inserted into the intervertebral space, and the position of the intervertebral space can be confirmed after the film is taken. 5. Disc herniation The micro-drill is applied to the ventral side of the intervertebral foramen, i.e., the base of the projection is drilled so that the protruding disc portion is suspended. Then, with a curette or a micro chisel, the protruding nucleus pulposus or ossified tissue is completely removed in a direction away from the dural sac, and the compression of the spinal cord is completely relieved. 6. Close the chest A drainage tube is built in the chest cavity, and a small incision is made in the other rib space under the surgical incision. The tube end is wrapped with gauze and bundled with rubber bands. The chest wall is sutured layer by layer. complication 1. The gas or effusion in the chest cavity can be absorbed by itself. Thoracentesis should be performed when there is tension pneumothorax. 2. Postoperative lower limb numbness, weakness, multi-system traction caused by dural sac, can gradually recover. 3. Others with the same general thoracotomy.