Surgery for Giant Calcified Herniated Thoracic Discs: A Systematic Review

Gong, Min; Liu, Guoming; Guan, Qing; Li, Lang; Xing, Fei; Xiang, Zhou

doi:10.1016/j.wneu.2018.06.232

Cited by 17 publications

(13 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 18 Most surgeons recommend surgical treatment for giant herniated thoracic discs (HTDs) and giant calcified HTDs because those HTDs frequently lead to the development of myelopathy (up to 97%). 19 However, some also consider operative management in certain cases where patients with myelopathy signs are evident on MRI, even in the absence of neurological symptoms. These patients may benefit from surgical treatment before symptoms appear or, worse, become irreversible ( Fig.…”

Section: Thoracic Disc Herniationmentioning

confidence: 99%

Herniated discs: when is surgery necessary?

Yoon

Koch

2021

EFORT Open Reviews

View full text Add to dashboard Cite

In all levels of disc herniations the absolute surgical indications include deteriorating neurological deficits with myelopathy or cauda equina syndrome. However, this review summarized the relative indications for surgery in each level. In cervical disc herniation (CDH), the indications for surgery consist of six months of persisting symptoms, not responding to conservative treatment. However, high-quality studies are lacking, and a randomized controlled trial is now underway to clarify the indications. In thoracic disc herniation (TDH), the indications for surgery comprise failure of conservative measures and/or worsening neurological symptoms. Moreover, giant calcified thoracic disc herniations or myelopathy signs on magnetic resonance imaging, even in the absence of neurological symptoms, may benefit from surgical treatment as a preventive measure. In lumbar disc herniation (LDH), the indications for surgery include imaging confirmation of LDH, consistent with clinical findings, and failure to improve after six weeks of conservative care. Cite this article: EFORT Open Rev 2021;6:526-530. DOI: 10.1302/2058-5241.6.210020

show abstract

Section: Thoracic Disc Herniationmentioning

confidence: 99%

Herniated discs: when is surgery necessary?

Yoon

Koch

2021

EFORT Open Reviews

View full text Add to dashboard Cite

show abstract

“…In singular cases, it is reported that calcified herniations are an extension of a calcified nucleus pulposus. 6 The debut of TDHs varies according to the affected level. In most of the cases, thoracic back pain is the main complaint.…”

Section: Epidemiology and Clinical Featuresmentioning

confidence: 99%

“…The calcification mechanism has not been elucidated yet. In singular cases, it is reported that calcified herniations are an extension of a calcified nucleus pulposus [ 6 ].…”

Section: Epidemiology and Clinical Featuresmentioning

confidence: 99%

Transforaminal Endoscopic Thoracic Discectomy: Technical Review to Prevent Complications

Choi

Muñoz-Suárez

2020

Neurospine

View full text Add to dashboard Cite

For all the spine surgeons, thoracic disc herniations (TDHs) entrust a real challenge in terms of patient diagnosis, proper selection, surgical technique, and potential adverse events. TDHs are relatively uncommon compared to the lumbar and cervical levels. Literature reports a variable prevalence of TDHs around 6% to 40%, but less than 1% of all disk herniations are symptomatic TDHs, evidencing as a relatively unusual condition. Nowadays, transforaminal endoscopic thoracic discectomy (TETD) has been implemented as an alternative to classic open procedures with results that are as good as and, in some situations, better than those in traditional discectomy. However, the surgeon must be familiar with endoscopic lumbar spine surgery before opting to perform a TETD, considering that the learning curve is much harder. We describe all the steps and safety considerations during TETD based on the anatomic differences compared to lumbar endoscopic procedures. TETD is an effective and safe method that yields more benefits, provides a direct route to the lesion with less morbidity, and is performed in a minimally invasive way. Many severe complications related to the thoracic region could be avoided having the proper knowledge, adequate technique, and safety routes and considerations.

show abstract

“…Giant TDH occupy more than 40% of the canal diameter on CT or MRI [36]. Identification of these herniations is important because they are frequently associated with myelopathy, are calcified in 90% of cases, and may have an intradural extension [34,37]. These attributes make them difficult to manage surgically [38].…”

Section: Giant Thoracic Disc Herniationsmentioning

confidence: 99%

“…Hott et al [36] described 2-level corpectomy and fixation as the standard of care for patients with giant TDH. A few authors have also reported thoracoscopy to be associated with unfavorable outcomes leading to neurological deterioration [37]. Our recommendation for these herniations is to approach them via a mini-open thoracotomy or the retropleural approach.…”

Section: Giant Thoracic Disc Herniationsmentioning

confidence: 99%

A Review of Minimally Invasive Surgical Techniques for the Management of Thoracic Disc Herniations

Sharma

Kim

2019

Neurospine

View full text Add to dashboard Cite

Thoracic disc herniation (TDH) is a rare, but technically challenging, disorder. Apart from their unfamiliarity with this condition, surgeons are often posed with challenges regarding the diverse methods available to address TDH, the neurological disturbances accompanying the disorder, the prospect of iatrogenic cord damage during surgical procedures, and the complications associated with various surgical approaches. In today’s era, when minimally invasive surgery has been incorporated into almost every aspect of managing spine disorders, it is necessary for surgeons to be aware of the various minimally invasive techniques available for the management of these rare and difficult conditions. In this review article, we provide a synopsis of the epidemiology, clinical features, and technical aspects of TDH, starting from level identification to intraoperative neuromonitoring and including important steps and guidance for all the minimally invasive approaches to TDH. We conclude the review by providing insights into the clinical decision-making process and outline the specific aspects of “giant” thoracic discs and indications for fusion in certain conditions. Outcomes of minimally invasive surgery for these conditions are generally favorable. The location of herniation is an important factor for surgical planning.

show abstract

Surgery for Giant Calcified Herniated Thoracic Discs: A Systematic Review

Cited by 17 publications

References 34 publications

Herniated discs: when is surgery necessary?

Herniated discs: when is surgery necessary?

Transforaminal Endoscopic Thoracic Discectomy: Technical Review to Prevent Complications

A Review of Minimally Invasive Surgical Techniques for the Management of Thoracic Disc Herniations

Contact Info

Product

Resources

About