• David Brauge, Rachid Madkouri, Vincent Reina, Saad Bennis, Bertrand Baussart, Etienne Mireau, Sorin Aldea, and Stephan Gaillard.
• Service de Neurochirurgie, Hôpital Foch, Suresnes, France; Institut de Biomécanique Humaine Georges Charpak Arts et Métiers Paris Tech, Paris, France. Electronic address: d.brauge@hopital-foch.com.
• World Neurosurg. 2017 Nov 1; 107: 744-749.

BackgroundAcute myelopathy in cases of thoracic disc herniation (TDH) is an exceptional condition for which the treatment is not codified. Here we present the results of a standardized procedure in 10 patients who underwent surgery for acute myelopathy on TDH between December 2009 and December 2016.MethodsOur approach began with a cautious laminectomy without resection of the hernia on the day of admission. On subsequent days, a complementary thoracoscopic procedure was performed according to the patient's neurologic recovery and the nature of the hernia (calcified or fibrous). Outcome was assessed by the Frankel score at the last consultation.ResultsAll patients had acute myelopathy, with Frankel score of C or worse and a TDH detected on magnetic resonance imaging occupying an average of 62.5 ± 18.4% of the canal. This lesion was calcified in 6 cases and soft in 4 cases. The laminectomy allowed stabilization in 1 case and a neurologic improvement in 9 cases. Complementary surgery via a thoracoscopic approach was performed in the 6 cases of calcified hernia. After an average follow-up of 44.55 ± 26.44 months, 6 patients showed complete neurologic recovery and 4 had moderate sequelae (Frankel D).ConclusionsLaminectomy appears to allow stabilization of the neurologic situation in rare cases of acute myelopathy on TDH. The need for complementary resection of the hernia by an anterior approach should always be discussed secondarily.Copyright © 2017 Elsevier Inc. All rights reserved.

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