PURPOSE Surgical treatment failures or strategies for the reoperation of residual thoracic disc herniations are sparsely discussed. We investigated factors that led to incomplete disc removal and recommend reoperation strategies. METHODS As a referral centre for thoracic disc disease, we reviewed retrospectively the clinical records and imaging studies before and after the treatment of patients who were sent to us for revision surgery for thoracic disc herniation from 2013 to 2018. RESULTS A total of 456 patients were treated from 2013 to 2018 at our institution. Twenty-one patients had undergone previously thoracic discectomy at an outside facility and harboured residual, incompletely excised and symptomatic herniated thoracic discs. In 12 patients (57%), the initial symptoms that led to their primary operation were improved after the first surgery, but recurred after a mean of 2.8 years. In seven patients (33%) they remained stable, and in two cases they were worse. All patients were treated via all dorsal approaches. In all 21 cases, the initial excision was incomplete regarding medullar decompression. All of the discs were removed completely in a single revision procedure. After mean follow-up of 24 months (range 12-57 months), clinical neurological improvement was demonstrated in seven patients, while three patients suffered a worsening and 11 patients remained stable. CONCLUSION Our data suggest that pure dorsal decompression provides a short relief of the symptoms caused by spinal cord compression. Progressive myelopathy (probably due to mechanical and vascular deficits) and scar formation may cause worsening of symptoms. These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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胸椎间盘突出症的修订手术。

目的稀疏讨论残余胸椎间盘突出症再手术的手术失败或策略。我们调查了导致未完全取出光盘的因素，并建议了重新手术策略。方法作为2013年至2018年被送往我们进行胸椎间盘突出症翻修手术的患者的治疗前后，我们回顾性分析了胸椎疾病的转诊中心。结果共有456例患者被纳入研究。从2013年到2018年在我们机构接受治疗。21名患者先前曾在外部设施进行过胸椎间盘切除术，并保留了残留的，不完全切除且有症状的椎间盘突出症。在12位患者（57％）中，首次手术后，导致其初次手术的最初症状有所改善，但在平均2.8年后复发。在7例患者（33％）中，他们保持稳定，而在2例中，情况更糟。所有患者均通过所有背侧入路治疗。在所有21例中，关于髓样减压的最初切除术均不完全。所有光盘都在一个修订过程中被完全删除。在平均随访24个月（范围12-57个月）后，有7例患者表现出临床神经功能改善，而3例患者恶化，11例患者保持稳定。结论我们的数据表明，单纯的背侧减压可以短暂缓解脊髓压迫引起的症状。进行性脊髓病（可能是由于机械和血管缺陷）和疤痕形成可能导致症状恶化。这些幻灯片可以在电子补充材料下找到。