Interdisciplinary Neurosurgery (Jun 2022)
Symptom distribution and development in thoracic disc surgery – A retrospective case series of 664 patients
Abstract
Objective: The incidence of surgically treated thoracic disc herniations in the U.S. is estimated to be 1:116,338 [1]. The disease poses 2 main challenges: 1) Surgical removal and 2) early and correct diagnosis. It is without doubt that herniated thoracic discs can be difficult to remove; Equally difficult is often enough attributing the correct symptoms to the disease that lead to the diagnosis, because there is a great variability and supposedly low specificity of the clinical symptoms, especially concerning pain related symptoms, which are often attributed to muscular or joint related causes.The series published so far are comparatively small (up to a maximum of 200) to give a good and valid overview of the symptoms that the disease can cause.The aim of this study was therefore to verify and falsify the previously published data that were obtained with small series on the basis of a much larger series. Methods: We used our practice's own database that was designed to included only patients with thoracic disc herniations since the senior author focused on this disease about 25 years ago. The patient's symptoms were initially recorded descriptively on the basis of the medical record. Then the patients were contacted and the development of symptoms after surgery and new symptoms were recorded. Results: 664 patients were included in the study. Mean follow-up period was 57.89 months. 151 (22.74%) patients reported neurological motor deficits, 313 (47.13%) reported neurological sensory deficits, 542 (81.62%) thoracic back pain, 125 (18.82%) bladder and rectal dysfunction and 46 (6.92%) atypical symptoms. 137 (20%) of the patients were completely symptom-free. The rate of improvement/ symptom stability was about 90% for neurological symptoms, pain-improvement 40%, 65% improvement in bladder and rectal dysfunction, and 80% improvement in atypical symptoms. Conclusion: The results of this largest series to date of patients who were operated on for a thoracic disc herniation show that not only neurological but also algetic symptoms are dominating in patients harboring this disease. The postoperative results primarily help to advise the patient on their prognosis.
