Descompresión medular mediante abordaje lateral transtorácico mínimamente invasivo. Reporte de un caso. [Spinal cord decompression by minimally invasive transthoracic lateral approach. Case report]

Augusto Esteban Martínez, Felipe Jose Lanari Subiaur, Carlos María Mounier, José Ricardo Prina, Ramiro Gutiérrez, Enrique Augusto Gobbi

Resumen


Existen múltiples técnicas para la descompresión medular en la columna torácica, cada una con sus ventajas y desventajas y con distintos requerimientos de destrezas quirúrgicas. Se han desarrollado técnicas mínimamente invasivas que disminuyen las tasas de morbilidad, con buenos resultados funcionales. Se presenta el caso de un hombre de 64 años, con clínica de compresión medular, una hernia de disco central, calcificada a nivel del quinto disco torácico, migrada hasta el borde inferior de la sexta vértebra torácica, con franca compresión medular. Se realizó un abordaje lateral transpleural mínimamente invasivo, con una corpectomía parcial posterior de la sexta vértebra, sin fijación adicional. El paciente tuvo una buena evolución, sin progresión del cuadro neurológico ni dolor costal residual.

Los abordajes laterales mínimamente invasivos son técnicas válidas para tratar patologías compresivas de la columna torácica, con bajas tasas de morbimortalidad y una rápida recuperación.

 

Abstract

There are multiple techniques for spinal cord decompression in the thoracic spine, each with its advantages and disadvantages, and requiring different surgical skills. Recently, minimally invasive techniques have been developed, reducing morbidity rates and achieving good functional results.

We present the case of a 64-year-old male with spinal compression symptoms, central disc herniation calcified at the fifth thoracic vertebra, which migrated to the lower end of the sixth thoracic vertebra. Diagnosis was clear for spinal cord compression. Partial posterior corpectomy of the sixth vertebra was performed with a minimally invasive transthoracic transpleural lateral approach and without additional fixation. The patient had a good outcome on follow-up, without progression of neurological symptoms or residual rib pain.

Minimally invasive lateral approaches are valid techniques for the treatment of compression disorders of the thoracic spine, with low rates of morbidity and mortality, and a rapid recovery.


Palabras clave


Columna; abordaje mininvasivo; descompresión; toracotomía.Spine; minimally invasive approach; decompression; thoracotomy.

Texto completo:

PDF PDF (English)

Cantidad de visitas / Visitor counter
Resumen - 82
PDF - 0 PDF (English) - 0

Referencias


Louge V. Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 1952;15(4):227-41. DOI:10.1136/jnnp.15.4.227

Arseni C, Nash F. Thoracic intervertebral disc protrusion: a clinical study. J Neurosurg 1960;17:418-30.

DOI: 10.3171/jns.1960.17.3.0418

Hulme A. The surgical approach to thoracic intervertebral disc protrusions. J Neurosurg Psychiatry 1960;23:133-7. Doi: 10.1136/jnnp.23.2.133

Le roux PD, Haglund MM, Harris AB. Thoracic disc disease: experience with the transpedicular approach in twenty

consecutive patients. Neurosurgery 1993;33:58-66. DOI:10.1097/00006123-199307000-00009

Perot Jr PL, Munro DD. Transthoracic removal of midline thoracic disc protrusions causing spinal cord compression. J Neurosurg 1969;31:452-8. DOI:10.3171/jns.1969.31.4.0452

Rosenthal D, Rosenthal R, de Simone A. Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine 1994;19(9):1087-91. DOI: 10.1097/00007632-199405000-00018

Dakwar E, Ahmadian A, Uribe JS. The anatomical relationship of the diaphragm to the thoracolumbar junction during the minimally invasive lateral extracelomic (retropleural/retroperitoneal) approach. J Neurosurg Spine 2012;16:359-64.

DOI: 10.3171/2011.12.SPINE11626

Uribe JS, Smith WD, Pimenta L, Hartl R, Dakwar E, Modhia UM. Minimally invasive lateral approach for symptomatic thoracic disc herniation: initial multi-center clinical experience. J Neurosurg Spine 2012;16:264-79. DOI: 10.3171/2011.10.SPINE11291

Karmakar MK, Ho AM. Postthoracotomy pain syndrome. Thora Surg Clin 2004;14:345-52. DOI:10.1016/S1547-4127(04)00022-2

Hann PP, Kenny K, Dickman CA. Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures. Neurosurgery 2002;52(Suppl 5):88-95. DOI:10.1097/00006123-200211002-00013

McAfee PC, Regan JR, Zdeblick T, Zuckerman J, Picetti GD 3rd, Heim S, et al. The incidence of complications in endoscopic anterior thoracolumbar spinal reconstructive surgery. A prospective multicenter study comprising the first 100 consecutive cases. Spine (Phila PA 1976) 1995;20:1624-32. DOI:10.1097/00007632-199507150-00012

Deviren V, Kuelling FA, Poulter G, Pekmezci M. Minimal invasive anterolateral transthoracic transpleural approach: a novel technique for thoracic disc herniation. A review of the literature, description of a new surgical technique and experience with first 12 consecutive patients. J Spinal Disord Tech 2011;24:E40-8.

DOI: 10.1097/BSD.0b013e318220af6f

Nacar OA, Ulu MO, Pekmezci M, Deviren V. Surgical treatment of thoracic disc disease via minimally invasive lateral transthoracic trans/retropleural approach: analysis of 33 patients. Neurosurg Rev 2013;36:455-65. DOI: 10.1007/s10143-013-0461-2

Uribe JS, Dakwar E, Le TV, Christian G, Serrano S, Smith WD. Minimally invasive surgery treatment for thoracic spine tumor removal: a mini-open, lateral approach. Spine 2010;35:S347-54. DOI: 10.1097/BRS.0b013e3182022d0f

White AA III, Panjabi MM. Clinical biomechanics of the spine, 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 1990. ISBN-10: 0397507208




DOI: http://dx.doi.org/10.15417/issn.1852-7434.2019.84.1.833

Enlaces refback

  • No hay ningún enlace refback.




URL de la licencia: http://creativecommons.org/licenses/by-nc-sa/4.0/deed.es

Registro de la Propiedad Intelectual Nº 22171081 (en línea).

ISSN 1852-7434 (en línea).

Esta Revista está bajo una Licencia Creative Commons Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional. (CC-BY-NC-SA 4.0)