Posterior Minimally Invasive Transpedicular Approach for Giant Calcified Thoracic Disc Herniation

Abstract

<jats:sec><jats:title>Study Design:</jats:title><jats:p> Retrospective case series. </jats:p></jats:sec><jats:sec><jats:title>Objective:</jats:title><jats:p> Posterior surgery for thoracic disc herniation was associated with increased morbidity and mortality and new minimally invasive approaches have been recommended for soft disc herniation but not for calcified central disc. The objective of this study is to describe a posterolateral microscopic transpedicular approach for central thoracic disc herniation. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> This is a single center retrospective review of all the cases of giant thoracic calcified disc herniation as defined by Hott et al. Presence of myelopathy, percentage of canal compromise, T2 hypersignal, ASIA score, and ambulatory status were recorded. This posterolateral technique using a tubular retractor was thoroughly described. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Eight patients were operated upon with a mean follow-up of 16 months. Mean canal compromise was 61%. Mean operative time was 228 minutes and mean operative bleeding was 250 mL. There were no cases of dural tear or neurologic degradation. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> This is the first report of posterior minimally invasive transpedicular approach for giant calcified disc herniation. There were neither cases of neurological deterioration nor increased rate of dural tears. This technique is thus safe and could be recommended for treatment of this rare disease. </jats:p></jats:sec>

Surgical Treatment of Calcified Thoracic Herniated Disc Disease via the Transthoracic Approach with the Use of Intraoperative Computed Tomography (iCT) and Microscope-Based Augmented Reality (AR)

“…There are several techniques which have been developed for the resection of the calcified thoracic discs: thoracic discectomy with ultrasound visualization via a unilateral transpedicular [ 14 , 15 , 16 ] or costotransversectomy approach [ 4 , 17 ]; anterior decompression and spinal fusion [ 3 ]; posterior circumspinal decompression and spinal fusion [ 3 ]; thoracotomy and hemivertebrectomy [ 18 ]; two-level corpectomy and instrumented stabilization through an open thoracotomy [ 2 ]; a mini-thoracotomy approach with anterior foraminotomy [ 19 ]; a mini-open thoracotomy and retropleural resection without the need for corpectomy or instrumentation [ 20 ]; a mini-open retropleural approach [ 21 ]; video-assisted thoracoscopic surgery [ 22 ]; thoracoscopic microdiscectomy [ 5 , 23 , 24 ]; a thoracoscopic transaxillary approach for T3–T4 herniations, with the use of cardiothoracic surgeons for access [ 25 ]; a minimally invasive dorsal approach, followed by stabilization [ 1 ]; the transthoracic endoscopic approach [ 26 , 27 ]; lateral retropleural discectomy [ 28 ]; transforaminal full endoscopic discectomy and foraminotomy under local anesthesia [ 29 ]; a posterior transdural approach using a three-dimensional exoscope [ 30 ]; a dual corridor method involving a tubular transthoracic/retropleural approach followed by a posterior transdural discectomy [ 31 ]; the posterior pedicle-sparing transfacet approach [ 14 , 32 , 33 ]; the full-endoscopic technique with interlaminar, extraforaminal, and transthoracic retropleural approaches [ 34 , 35 ]; circumspinal decompression and fusion through a posterior midline incision [ 6 ]; a minimally invasive transpedicular approach [ 36 ]; percutaneous endoscopic decompression using the T rigid bendable burr [ 37 ]; and the circumferential dural resection technique with corpectomies [ …”

Outpatient endoscopic resection of large calcified thoracic disc herniation with caudal displacement

“…Conclusively, we should also note that although these novel techniques can result in favorable outcomes, complex cases such as migrated large calcified thoracic discs can be challenging. [3][4][5][6] The importance of training in full-endoscopic procedures should be emphasized, and these cases are likely best reserved for surgeons with sufficient clinical experience and volume in full-endoscopic spine procedures. 7…”

Posterior transdural resection of giant calcified thoracic disc herniation in a case series of 12 patients

“…Compared with the transthoracic approach, the duration of the transdural posterior approach is much shorter (mean duration in transthoracic surgery of giant thoracic disc herniation ranging from 251 min [17] to 344 min [16]). In July 2020, Shedid et al [18] published a case series of 8 patients undergoing a posterolateral microscopic transpedicular approach with a tubular retractor for giant thoracic disc herniations. In total, 3/8 patients required a posterior fixation in order to achieve sufficient decompression to visualize the disc herniation.…”