{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T12:21:30Z","timestamp":1793449290971,"version":"4.5.0"},"reference-count":47,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2013,12]]},"abstract":"\nObject<\/jats:title>\nSymptomatic herniated thoracic discs (HTDs) are rare, and patients infrequently require treatment of 2 or more disc levels. The authors assess the surgical management and outcomes of patients with multiple-level symptomatic HTDs.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nA retrospective review of a prospectively maintained database was performed of 220 consecutive patients treated surgically for symptomatic HTDs. Clinical and surgical results were compared between patients with single-level disease and patients with multiple-level disease and also among the different approaches used for surgical decompression.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nBetween 1992 and 2012, 56 patients (mean age 48 years; 26 male, 30 female) underwent 62 procedures for 130 HTDs. Forty-six patients (82%) had myelopathy, and 36 (64%) had thoracic radiculopathy; 24 patients had both conditions in varying degree. Symptom duration averaged 28 months. The surgical approach was dictated by disc size, consistency, and location. Twenty-three thoracotomy, 26 thoracoscopy, and 13 posterolateral procedures were performed. Five patients required a combination of approaches. Patients underwent 2-level (n = 44), 3-level (n = 7), 4-level (n = 4), or 5-level (n = 1) discectomies. Instrumented fusion was performed in 36 patients (64%). Thirteen patients harbored 19 additional discs, which were deemed asymptomatic\/nonoperative.<\/jats:p>\nThe mean hospital stay was 6.5 days. Complete disc resection was verified with postoperative imaging in every patient. The procedural complication rate was 23%, and the nature of complications differed based on approach. No patients had surgery-related spinal cord injury or new myelopathy.<\/jats:p>\nAt a mean follow-up of 48 months, myelopathy and radiculopathy had resolved or improved at a rate of 85% and 92%, respectively. Using a general linear model, preoperative symptom duration (p = 0.037) and perioperative hospital length of stay (p = 0.004) emerged as negative predictors of myelopathy improvement. Most patients (96%) were satisfied with the surgical results.<\/jats:p>\nCompared with 164 patients who underwent single-level HTD decompression, patients requiring surgery for multiple-level HTDs were more often myelopathic (p = 0.012). Surgery for multiple-level HTDs was more likely to require a thoracotomy approach (p = 0.00055) and instrumented fusion (p < 0.0001) and resulted in greater blood loss (p = 0.0036) and higher complication rates (p = 0.0069). The rates of resolution for myelopathy (p = 0.24) and radiculopathy (p = 1.0), however, were similar between the 2 patient groups.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nThe management of multiple-level symptomatic HTDs is complex, requiring individualized clinical decision making. The surgical approaches must be selected to minimize manipulation of the compressed thoracic spinal cord, and a patient may require a combination of approaches. Excellent surgical results can be achieved in this unique and challenging patient population.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.8.spine121041","type":"journal-article","created":{"date-parts":[[2013,10,11]],"date-time":"2013-10-11T14:58:46Z","timestamp":1381503526000},"page":"774-783","source":"Crossref","is-referenced-by-count":35,"title":["Surgical management and clinical outcomes of multiple-level symptomatic herniated thoracic discs"],"prefix":"10.3171","volume":"19","author":[{"given":"Mark E.","family":"Oppenlander","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin C.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Kalyvas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis A.","family":"Dickman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine121041","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1212\/WNL.6.1.1","article-title":"Protrusions of thoracic intervertebral disks","volume":"6","author":"Abbott","year":"1956"},{"key":"b2-spine121041","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1097\/00007632-200204150-00018","article-title":"Video-assisted thoracoscopic surgery for thoracic disc disease: Classification and outcome study of 100 consecutive cases with a 2-year minimum follow-up period","volume":"27","author":"Anand","year":"2002"},{"key":"b3-spine121041","series-title":"Neurol Clin","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/S0733-8619(18)31043-0","article-title":"Herniated thoracic disks","volume":"3","author":"Arce","year":"1985"},{"key":"b4-spine121041","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"76","DOI":"10.3171\/2011.3.SPINE10642","article-title":"Surgical management of multiple thoracic disc herniations via a transfacet approach: a report of 15 cases. 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