Overview
Thoracic disc prolapse with myelopathy (TDM) involves herniation of intervertebral discs in the thoracic spine leading to spinal cord compression and neurological deficits. Surgical intervention is often required to decompress the spinal cord and stabilize the spine 12.Diagnosis
Clinical Presentation: Neurological deficits including motor weakness, sensory loss, and possible sphincter dysfunction.
Imaging: MRI is essential for visualizing spinal cord compression, assessing spinal canal occupancy ratio, and identifying calcified herniated discs and cord morphology (e.g., U-shaped compression) 1.
Radiographic Parameters: Evaluation of spinal canal occupancy ratio, presence of calcified herniations, and cord compression patterns 1.Management
First-Line Treatment: Surgical decompression with or without fusion, including anterior/anterolateral decompression and spinal fusion (ASF), posterior/posterolateral decompression and spinal fusion (PSF), and disc decompression/excision without fusion (DDE) 2.
Surgical Approaches:
- ASF: Preferred in younger patients, involves anterior approach 2.
- PSF: Gained popularity over the study period, involving posterior decompression and fusion 2.
- DDE: Less common in recent years but still utilized 2.
Intraoperative Considerations: Minimizing intra-operative blood loss (<1500 mL) and avoiding anterior approaches in cases with high spinal canal occupancy ratio (>75%) and specific cord morphologies 1.Special Populations
Elderly: Trends suggest a shift towards PSF, possibly due to lower complication risks in this population, though specific recommendations vary 2.
Comorbidities: Patients with higher spinal canal occupancy ratio and specific cord compression patterns (e.g., U-shaped) may have increased risk of post-operative neurological deterioration 1.Key Recommendations
Preoperative Imaging: Utilize MRI to assess spinal canal occupancy ratio, presence of calcified herniations, and cord morphology to predict surgical risks (Evidence: Moderate) 1.
Surgical Approach Selection: Consider PSF over DDE, especially in recent trends, and avoid anterior approaches in cases with high spinal canal occupancy ratio and specific cord compression patterns (Evidence: Moderate) 12.
Monitor Intraoperative Blood Loss: Aim to minimize blood loss to reduce the risk of post-operative neurological deterioration (Evidence: Moderate) 1.References
1 Yuan L, Chen Z, Li W, Sun C, Liu Z, Liu X. Risk factors associated with post-operative neurological deterioration in patients with thoracic disc disorders with myelopathy. International orthopaedics 2021. link
2 Jain A, Menga EN, Hassanzadeh H, Jain P, Lemma MA, Mesfin A. Thoracic disc disorders with myelopathy: treatment trends, patient characteristics, and complications. Spine 2014. link