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

Abstract

Calcified thoracic disc herniations present a rare and challenging entity. Due to the close proximity to the spinal cord and relative narrowing of the spinal canal, the optimal approach remains a matter of debate. While the transthoracic approach is usually preferred, we adapted a new technique described in 2012: the transdural posterior approach. Our aim was to evaluate its benefits in patients with giant thoracic disc protrusions. We retrospectively reviewed all patients treated in our neurosurgical department from July 2012 to March 2020. Demographics, pre- and postoperative clinical status, and operative technique and complications were extracted and analyzed. In total, 12 patients underwent a posterior transdural resection of giant calcified thoracic hard discs between 2012 and 2020. All patients underwent a posterior decompression (laminectomy, hemilaminectomy, or laminoplasty). The median duration of surgery was 152 min. Transient postoperative neurological deterioration occurred in 4 patients, with complete recovery until time of discharge. No patient underwent a surgical revision. The transdural resection of giant calcified thoracic hard discs through a posterior approach provides an excellent decompression with sufficient visualization of the spinal cord and a satisfying postoperative outcome.

Keyhole Fenestration for Cerebrospinal Fluid Leaks in the Thoracic Spine: Quantification of Bone Removal and Microsurgical Anatomy

“…27 Transdural approaches are also described by (hemi-)laminectomy, laminoplasty or partial facetectomy, and pediculectomy. [28][29][30] In some of these approaches, removing of weight-bearing elements is an intrinsic part of the procedure (eg, facetectomy, 22,25 transpedicular [22][23][24] ). Accordingly, stabilizing surgery is occasionally necessary and sometimes performed directly using the same procedure.…”

“…27 Transdural approaches are also described by (hemi-)laminectomy, laminoplasty or partial facetectomy, and pediculectomy. 28-30…”

Der thorakale Bandscheibenvorfall

“…Beim transduralen Zugang führt die Resektion der Ligg. denticulata zu einem leichten Rückzug des Myelons nach dorsal, was den notwendigen Arbeitsraum gewährt, um wiederum transdural (also 2-fach) an den Vorfall zu gelangen [19]. Arbeiten aus dem asiatischen Raum propagieren einen Zugang mit uni-oder biliateraler Transfacettektomie und postulieren, dieser würde ohne eine Retraktion des Myelons auskommen [20,21,22].…”

Lateral Retropleural Thoracic Diskectomy for a Calcified Herniated Disk: 2-Dimensional Operative Video

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Thoracic herniated disks are a rare subset of disk herniations that often require complex surgical intervention. [1][2][3][4][5][6][7][8][9][10][11][12] Furthermore, giant calcified thoracic disks are a leading contributor to myelopathy and postoperative complications. 8 Traditional approaches to the thoracic spine have been limited to open thoracotomies which are associated with significant morbidity and chest wall injury.

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