Sažetak
Uvod. U literaturi je opisano nekoliko načina pristupa torakalnom segmentu kičmenog stuba, ali postoji još uvek mnogo dilema u vezi sa tim šta je najbolje učiniti nakon završene diskektomije, bez obzira na izabrani hirurški pristup. Incidencija postoperativne kifoze je veća ako se izvodi posteriorni hirurški pristup kičmenom stubu, a ne postoje jasno definisane indikacije za primenu intervertebralne fuzije (IF) nakon anteriornog pristupa. Cilj rada bio je da se istakne nizak morbiditet transtorakalnog multidisciplinarnog pristupa, kao i potencijalno rešenje za dobru, prirodnu IF susednih pršljenova bez proširivanja i produženog trajanja same hirurške procedure. Prikaz bolesnika. Kod bolesnice stare 44 godina nađena je izražena prednja kompresivna mijelopatija izazvana kalcifikovanom torakalnom diskus hernijom u prostoru između pršljena T10-11. Izveden je minimalno invazivni, otvoreni, transtorakalni pristup sa dekompresijom kičmenog kanala na navedenom nivou i u istom aktu je postignuta IF autolognim graftom rebra. Uprkos relativno niskoj incidenciji postoperativne nestabilnosti kičmenog stuba, ne treba da se zanemari potreba za IF i sprečavanje dugoročnih komplikacija. Kontrolni pregled torakolumbalnog segmenta magnetnom rezonancom pokazao je da više nema kompresije kičmene moždine a takođe je pokazao i dobru IF bez povećanja kifoze. Zaključak. Velika hernijacija torakalnog diskusa je retka i hirurški veoma zahtevna. Prednji transtorakalni pristup omogućava jasnu ekspozicju relevantnih struktura i smatra se minimalno invazivnim. Prednosti naknadne IF nakon transtorakalnog hirurškog pristupa uvek treba uzeti u obzir za svakog bolesnika ponaosob, čime se postoperativni morbiditet svodi na minimum.
Ključne reči
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