Situation
Mr. C.E. is a 43-year-old building
contractor from Reno, Nevada who developed chest pain and weakness in his legs after
lifting a heavy crate at work. Over the next several days the patient lost control of his
urine and was unable to walk. An MRI of the thoracic spine indicated a disc rupture that
was compressing the spinal cord (Figure 17). The patient was told by his local doctor that
he would require a thoracotomy or "have his chest cracked" in order to take care
of the problem (Figure 18). These operations are painful and require a long recovery.
Figure 17. MRI reveals a disc fragment (5) compressing the spinal
cord as the cause for the patient’s paralysis.
Figure 18. Example of thoracotomy incision. The lung is retracted to expose the
spine.
Treatment
A second opinion told the patient to see Dr. McCormack
who could perform the same surgery working through small ports placed in the chest with
only one or two days hospitalization. Dr. McCormack was able to remove the disc using
small cuts on the patient’s chest and equipment similar to that used for knee
arthroscopy. (Figure 19)
Figure 19. Schematic drawing of spinal instruments inserted through small
"portal" incisions to operate on the spine.
Figure 20. Insertion of ports through small incisions to allow operation.
Figure 21. Intraoperative photo showing retraction of the lung to expose the spine.
Figure 22A. Postoperative photo showing wounds from small incision
points (note: compare to large thoracotomy incision in Figure 18).
Figure 22B. Postoperative MRI after thorascopic disc removal
(sagittal view)
Figure 22C. Postoperative MRI after thorascopic disc removal (axial view)
The patient made a complete recovery and was back at
work in 6 weeks.
Patient Comment
"I have 4 children and have to work. My legs were fully recovered
and I was back at work in 6 weeks after the thoracoscopy; with the other operation
(thoracotomy) I would have been out of work for months."
Next case
Copyright the Neurospine Institute 1998.
Last edited 09/22/98.
