International Orthopaedics

, Volume 43, Issue 4, pp 817–823 | Cite as

Thoracic disc herniation, avoidance, and management of the surgical complications

  • William A. Robinson
  • Ahmad N. Nassr
  • Arjun S. SebastianEmail author
Review Article


Thoracic disc herniations are a relatively rare occurrence compared to disc herniations in the cervical or lumbar spine. Surgical management of these thoracic herniations can be technically difficult with a wide array of reported complications. In this study, we aim to describe the most common complications that can occur during or after surgical management of thoracic disc herniations. Furthermore, we describe tips and tricks for avoidance and, if necessary, management of surgical complications. Common complications addressed in this review include vertebral column instability, neurologic injury, cerebrospinal fluid leak/pleural fistula, thoracic viscera injury, wrong level surgery, incomplete disk resection, and intercostal neuralgia.


Thoracic disc herniation Complications Avoidance of complications Management of complications Thoracic spine surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


  1. 1.
    Dietze DD Jr, Fessler RG (1993) Thoracic disc herniations. Neurosurg Clin N Am 4:75–90. CrossRefPubMedGoogle Scholar
  2. 2.
    Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR (2010) Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. J Neurosurg Spine 12:221–231. CrossRefPubMedGoogle Scholar
  3. 3.
    Cornips EM, Janssen ML, Beuls EA (2011) Thoracic disc herniation and acute myelopathy: clinical presentation, neuroimaging findings, surgical considerations, and outcome. J Neurosurg Spine 14:520–528. CrossRefPubMedGoogle Scholar
  4. 4.
    Hulme A (1960) The surgical approach to thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 23:133–137. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Love JG, Kiefer EJ (1950) Root pain and paraplegia due to protrusions of thoracic intervertebral disks. J Neurosurg 7:62–69. CrossRefPubMedGoogle Scholar
  6. 6.
    Currier BL, Eismont FJ, Green BA (1994) Transthoracic disc excision and fusion for herniated thoracic discs. Spine 19:323–328. CrossRefPubMedGoogle Scholar
  7. 7.
    el-Kalliny M, Tew JM Jr, van Loveren H, Dunsker S (1991) Surgical approaches to thoracic disc herniations. Acta Neurochir 111:22–32. CrossRefPubMedGoogle Scholar
  8. 8.
    Maiman DJ, Larson SJ, Luck E, El-Ghatit A (1984) Lateral extracavitary approach to the spine for thoracic disc herniation: report of 23 cases. Neurosurgery 14:178–182. CrossRefPubMedGoogle Scholar
  9. 9.
    Mulier S, Debois V (1998) Thoracic disc herniations: transthoracic, lateral, or posterolateral approach? A review. Surg Neurol 49:599–608. CrossRefPubMedGoogle Scholar
  10. 10.
    Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH (1998) Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg 88:623–633. CrossRefPubMedGoogle Scholar
  11. 11.
    Stillerman CB, Chen TC, Day JD, Couldwell WT, Weiss MH (1995) The transfacet pedicle-sparing approach for thoracic disc removal: cadaveric morphometric analysis and preliminary clinical experience. J Neurosurg 83:971–976. CrossRefPubMedGoogle Scholar
  12. 12.
    He B, Yan L, Xu Z, Guo H, Liu T, Hao D (2014) Treatment strategies for the surgical complications of thoracic spinal stenosis: a retrospective analysis of two hundred and eighty three cases. Int Orthop 38:117–122. CrossRefGoogle Scholar
  13. 13.
    Nayak NR, Bauman JA, Stein SC, Thawani JP, Malhotra NR (2017) Surgical approaches for the treatment of thoracic disk herniation: results of a decision analysis. Clin Spine Surg 30:E901–E908. CrossRefPubMedGoogle Scholar
  14. 14.
    Ridenour TR, Haddad SF, Hitchon PW, Piper J, Traynelis VC, VanGilder JC (1993) Herniated thoracic disks: treatment and outcome. J Spinal Disord 6:218–224. CrossRefPubMedGoogle Scholar
  15. 15.
    Ayhan S, Nelson C, Gok B, Petteys RJ, Wolinskiy JP, Witham TF, Bydon A, Gokaslan ZL, Sciubba DM (2010) Transthoracic surgical treatment for centrally located thoracic disc herniations presenting with myelopathy: a 5-year institutional experience. J Spinal Disord Tech 23:79–88. CrossRefPubMedGoogle Scholar
  16. 16.
    Vollmer DG, Simmons NE (2000) Transthoracic approaches to thoracic disc herniations. Neurosurg Focus 9:e8. CrossRefPubMedGoogle Scholar
  17. 17.
    Yang X, Liu X, Zheng Y (2014) Surgical treatment of thoracic disc herniations using a modified transfacet approach. Indian J Orthop 48:158–162. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Fessler RG, Sturgill M (1998) Review: complications of surgery for thoracic disc disease. Surg Neurol 49:609–618. CrossRefPubMedGoogle Scholar
  19. 19.
    Turgut M (1998) Three-level thoracic disc herniation: case report and review of the literature (P. G. Korovessis et al., ESJ 1997, Vol. 6, p. 74-76). Eur Spine J 7:348–350. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Maiman DJ, Pintar FA (1992) Anatomy and clinical biomechanics of the thoracic spine. Clin Neurosurg 38:296–324PubMedGoogle Scholar
  21. 21.
    Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8:817–831. CrossRefGoogle Scholar
  22. 22.
    Berg EE (1993) The sternal-rib complex. A possible fourth column in thoracic spine fractures. Spine 18:1916–1919. CrossRefPubMedGoogle Scholar
  23. 23.
    Takeuchi T, Abumi K, Shono Y, Oda I, Kaneda K (1999) Biomechanical role of the intervertebral disc and costovertebral joint in stability of the thoracic spine. A canine model study. Spine 24:1414–1420. CrossRefPubMedGoogle Scholar
  24. 24.
    Liebsch C, Graf N, Appelt K, Wilke HJ (2017) The rib cage stabilizes the human thoracic spine: an in vitro study using stepwise reduction of rib cage structures. PLoS One 12:e0178733. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Arce CA, Dohrmann GJ (1985) Herniated thoracic disks. Neurol Clin 3:383–392. CrossRefPubMedGoogle Scholar
  26. 26.
    Court C, Mansour E, Bouthors C (2018) Thoracic disc herniation: surgical treatment. Orthop Traumatol Surg Res 104:S31–S40. CrossRefPubMedGoogle Scholar
  27. 27.
    Vanichkachorn JS, Vaccaro AR (2000) Thoracic disk disease: diagnosis and treatment. J Am Acad Orthop Surg 8:159–169. CrossRefPubMedGoogle Scholar
  28. 28.
    Krauss WE, Edwards DA, Cohen-Gadol AA (2005) Transthoracic discectomy without interbody fusion. Surg Neurol 63:403–409. CrossRefPubMedGoogle Scholar
  29. 29.
    Quraishi NA, Khurana A, Tsegaye MM, Boszczyk BM, Mehdian SM (2014) Calcified giant thoracic disc herniations: considerations and treatment strategies. Eur Spine J 23(Suppl 1):S76–S83. CrossRefPubMedGoogle Scholar
  30. 30.
    Logue V (1952) Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 15:227–241. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Al-Mahfoudh R, Mitchell PS, Wilby M, Crooks D, Barrett C, Pillay R, Pigott T (2016) Management of giant calcified thoracic disks and description of the trench vertebrectomy technique. Global Spine J 6:584–591. CrossRefPubMedGoogle Scholar
  32. 32.
    Hott JS, Feiz-Erfan I, Kenny K, Dickman CA (2005) Surgical management of giant herniated thoracic discs: analysis of 20 cases. J Neurosurg Spine 3:191–197. CrossRefPubMedGoogle Scholar
  33. 33.
    Quint U, Bordon G, Preissl I, Sanner C, Rosenthal D (2012) Thoracoscopic treatment for single level symptomatic thoracic disc herniation: a prospective followed cohort study in a group of 167 consecutive cases. Eur Spine J 21:637–645. CrossRefPubMedGoogle Scholar
  34. 34.
    Gille O, Soderlund C, Razafimahandri JH, Mangione P, Vital JM (2006) Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy. Eur Spine J 15:537–542. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Roelz R, Scholz C, Klingler JH, Scheiwe C, Sircar R, Hubbe U (2016) Giant central thoracic disc herniations: surgical outcome in 17 consecutive patients treated by mini-thoracotomy. Eur Spine J 25:1443–1451. CrossRefPubMedGoogle Scholar
  36. 36.
    Strom RG, Mathur V, Givans H, Kondziolka DS, Perin NI (2015) Technical modifications and decision-making to reduce morbidity in thoracic disc surgery: an institutional experience and treatment algorithm. Clin Neurol Neurosurg 133:75–82. CrossRefPubMedGoogle Scholar
  37. 37.
    Moon SJ, Lee JK, Jang JW, Hur H, Lee JH, Sim SH (2010) The transdural approach for thoracic disc herniations: a technical note. Eur Spine J 19:1206–1211. CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    McCormick WE, Will SF, Benzel EC (2012) Surgery for thoracic disc disease. Complication avoidance: overview and management. Neurosurg Focus 9:e13. CrossRefGoogle Scholar
  39. 39.
    Yoshihara H, Honeoka D (2014) Incidental dural tear in spine surgery: analysis of a nationwide database. Eur Spine J 23:389–394. CrossRefPubMedGoogle Scholar
  40. 40.
    Rosenthal D, Rosenthal R, de Simone A (1994) Removal of a protruded thoracic disc using microsurgical endoscopy. A new technique. Spine 19:10887–11991. CrossRefGoogle Scholar
  41. 41.
    Hentschel SJ, Rhines LD, Wong FC, Gokaslan ZL, McCutcheon IE (2004) Subarachnoid-pleural fistula after resection of thoracic tumors. J Neurosurg 100(4 Suppl Spine):332–326PubMedGoogle Scholar
  42. 42.
    Kurata Y, Yoshimoto M, Takebayashi T, Kawaguchi S, Yamashita T (2010) Subarachnoid-pleural fistula treated with noninvasive positive pressure ventilation: a two-case report and literature review. Spine 35:E908–E911. CrossRefPubMedGoogle Scholar
  43. 43.
    Shamji MF, Sundaresan S, Da Silva V, Seely J, Shamji FM (2011, 2011) Subarachnoid-pleural fistula: applied anatomy of the thoracic spinal nerve root. ISRN Surg:168959.
  44. 44.
    Rabassa AE, Nusynowitz ML (2005) Detection of subarachnoid pleural fistula. Neuroradiol 33:83–84. CrossRefGoogle Scholar
  45. 45.
    Nyunoya T, Gross T, Rooney C, Mendoza S, Kline J (2003) Massive pleural transudate following a vertebral fusion in a 49-year-old woman. Chest 123:1280–1283. CrossRefPubMedGoogle Scholar
  46. 46.
    Sahota S, Nassr A, Khan MH, Marsh RW, Moran SL, Arnold PM, Dekutoski MB (2012) Treatment of a thoracic dural-pleural fistula with a vascularized omental flap: a case report. Spine 37:E683–E685. CrossRefPubMedGoogle Scholar
  47. 47.
    Stillerman CB, Weiss MH (1992) Management of thoracic disc disease. Clin Neurosurg 38:325–352PubMedGoogle Scholar
  48. 48.
    Dickman CA, Rosenthal D, Regan JJ (1999) Reoperation for herniated thoracic discs. J Neurosurg 91(2 Suppl):157–162PubMedGoogle Scholar
  49. 49.
    Johnson JP, Drazin D, King WA, Kim TT (2014) Image-guided navigation and video-assisted thoracoscopic spine surgery: the second generation. Neurosurg Focus 36:E8. CrossRefPubMedGoogle Scholar
  50. 50.
    Bouthors C, Benzakour A, Court C (2018) Surgical treatment of thoracic disc herniation: an overview. Int Orthop.

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • William A. Robinson
    • 1
  • Ahmad N. Nassr
    • 1
  • Arjun S. Sebastian
    • 1
    Email author
  1. 1.Department of Orthopedic SurgeryMayo ClinicRochesterUSA

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