Thoracic Disk Herniation

Question 1

Thoracic disk herniation constitutes only 0.25% of herniated disks and usually occurs at or below T8. These disks are frequently calcified. Pain and sensory disturbance are in a band-like distribution radiating anteriorly and inferiorly along the involved root’s dermatome. What is the indication of surgery
in these cases?
● A. Refractory pain
● B. Progressive myelopathy
● C. Both A and B
● D. Radiculopathy
● E. None of the above

Answer 1

C. Both A and B

Question 2

CT should be obtained in cases of thoracic herniated disk along with noncontrast MRI of thoracic spine as most of the disks in this region are calcified. Which of the following are the options for open surgical approaches for these disks?
● A. Posterior midline laminectomy
● B. Posterolateral like lateral gutter (laminectomy plus removal of pedicle), transpedicular, costotransversectomy, and transfacet pedicle sparing
● C. Anterolateral (transthoracic) usually through the pleural space
● D. Lateral extracavitary (retrocoelomic) which is posterior to the pleural space
● E. All of the above

Answer 2

E. All of the above

Question 3

Which of the following is a correct match of appropriate surgical approach for the given pathology?
● A. Laminectomy for posteriorly located tumor
● B. Posterolateral (transpedicular) for radicular pain with lateral disk herniation or for biopsy of tumor
● C. Lateral (costotransversectomy) for midline disk, good ipsilateral access but poor access to opposite side
● D. Transthoracic for midline lesions especially for reaching both sides of the cord
● E. All of the above

Answer 3

E. All of the above

Question 4

To access T4–T5 disk space, which rib needs to be removed?
● A. T4
● B. T5
● C. Both A and B
● D. T5 and T6
● E. T4 and T3

Answer 4

B. T5

Question 5

Indications of transthoracic approach for thoracic disk disease include central fragment or calcified disk, and burst fracture of thoracic spine. Following are the advantages of transthoracic approach except?
● A. It provides excellent anterior approach
● B. It causes little compromise of stability
● C. It deals easily with pathology lying posterior to the cord
● D. There is low risk of mechanical cord injury with this approach
● E. All of the above

Answer 5

C. It deals easily with pathology lying posterior to the cord

Question 6

Which of the following statements regarding neuromonitoring during thoracic spine disease surgery is correct?
● A. It consists of MEP and SSEP
● B. It is not required for surgery at this level
● C. Injury to cord at this level cannot be prevented
● D. None of the above

Answer 6

A. It consists of MEP and SSEP

Question 7

There is risk of injury to radicular artery which may compromise the spinal cord blood supply. How much posterior rib along with transverse process needs to be removed?
● A. 3 to 4 cm
● B. 4 to 5 cm
● C. 5 to 3 cm
● D. More than 5 cm
● E. Less than 6 cm

Answer 7

B. 4 to 5 cm

Question 8

What skin incision can be used for costotransversectomy procedure?
● A. Curved paramedian skin incision
● B. Midline incision
● C. Both A and B
● D. T-shaped incision
● E. None of the above

Answer 8

C. Both A and B

Question 9

What is the most common symptom after thoracic disk herniation?
● A. Pain
● B. Sensory changes
● C. Motor changes
● D. All occur at some time

Answer 9

D. All occur at some time

Question 10

What is the percentage of occurrence pain in case of thoracic disk disease?
● A. 60%
● B. 23%
● C. 18%
● D. 8

Answer 10

A. 60%

Question 11

About 75% of thoracic disk herniations are below which level?
● A. T6
● B. T7
● C. T8
● D. T10
● E. T12

Answer 11

C. T8

Question 12

For thoracic spine surgery, which of the following is not a posterolateral approach?
● A. Transthoracic
● B. Lateral gutter
● C. Transpedicular
● D. Costotransversectomy
● E. Transfacet pedicle sparing

Answer 12

A. Transthoracic

Question 13

For a central disk herniation, especially when calcified, which approach has the lowest incidence of cord injury with the best operative results?
● A. Transfacet pedicle sparing
● B. Transthoracic
● C. Lateral extracavitary approach
● D. Costotransversectomy
● E. Transpedicular approach

Answer 13

B. Transthoracic

Question 14

Which of the following is the best approach for radicular pain with lateral disk herniation and biopsy of tumor?
● A. Transfacet pedicle sparing
● B. Transthoracic
● C. Lateral extracavitary approach
● D. Costotransversectomy
● E. Transpedicular approach

Answer 14

E. Transpedicular approach

Question 15

During costotransversectomy, to access the vertebral body of T6, which rib needs to be removed?
● A. 5th
● B. 7th
● C. 5th and 6th
● D. 6th and 7th
● E. 5th, 6th, and 7th

Answer 15

D. 6th and 7th

Question 16

What is the best approach for midline thoracic spine lesions, especially for reaching both sides of the cord?
● A. Laminectomy
● B. Posterolateral transpedicular
● C. Transpedicular facet sparing
● D. Costotransversectomy
● E. Transthoracic

Answer 16

E. Transthoracic