Surgical Treatment for Central Calcified Thoracic Disk Herniation: A Novel L-Shaped Osteotome

Abstract

Few reports are available on the posterior transfacet approach for the treatment of central calcified thoracic disk herniation (TDH). The objective of this study was to assess outcomes and complications in a consecutive series of patients with TDH who underwent posterior transfacet decompression and diskectomy with segmental instrumentation and fusion. The data for 27 patients (16 males and 11 females) were retrospectively reviewed and analyzed, including clinical presentation, blood loss, operative time, pre- and postoperative complications, visual analog scale, Japanese Orthopedic Association (JOA) score, and Frankel grade. All patients underwent trans-facet decompression and segmental instrumentation with interbody fusion. Mean patient age at surgery was 55.2 years (range, 21-81 years). Average follow-up was 30±19 months (range, 12-50 months). All patients were successfully treated with posterior decompression and segmental instrumentation with interbody fusion. Average operative time was 124±58 minutes (range, 87-180 minutes). Mean blood loss was 439±225 mL (range, 300-1500 mL). Average pre- and postoperative JOA scores were 4.12±0.87 and 8.01±0.97 points, respectively. Overall JOA scores showed a significant postoperative improvement. Overall recovery rates were excellent in 12 patients, good in 6, fair in 5, and unchanged in 1. No patient was classified as worse. The results suggest that the posterior approach using a special L-shaped osteotome is feasible. No major complications occurred while achieving adequate decompression for central calcified TDH.

Transforaminal Thoracic Interbody Fusion for Thoracic Disc Prolapse: Surgicoradiological Analysis of 18 Cases

“…TTIF yielded good outcome in other series as well (n ¼ 18, n ¼ 11, n ¼ 27, n ¼ 25, n ¼ 51) with minor or major complication rate of 33%, 18%, 3.70%, 12%, and 1.96% respectively. 8,10,[15][16][17] No deterioration due to cord handling noted in these series. No anticoagulants were given by us.…”

“… 9 However, posterior approach decompression with or without fusion has been advocated as an alternative and successful treatment modality in other reports. 10 – 17 One of the main problems is that an accomplished spine surgeon will see very low numbers of TDP in his life time. This makes long series reporting less likely.…”

Surgery of Thoracic Disc Herniation: A Systematic Review of English-Language Literature

“…Авторы публикаций, посвященных заднему доступу, видят его преиму-щество не только в меньшей частоте осложнений, но и в лучшей возможности контролировать эпидуральное пространство, его венозные сосуды и состояние твердой мозговой оболочки [7,19,22]. Разнообразие задних доступов расширяет возможности их применения и позволяет удалять не только мягкотканные латерально расположенные, но и медиальные оссифицированные грыжи диска [7,8,20,21,22,25]. Coppes et al [21], удалив 13 грыж из заднего трансдурального доступа, получили благоприятные результаты во всех наблюдениях.…”

What are the possibilities of spontaneous resorption of a thoracic disc herniation occupying more than 20% of the spinal canal in the asymptomatic subject? Comparative study

“…While the need for a surgical procedure is commonly accepted in cases of symptomatic hernia with a sign of myelopathy, the medical management of cases with an asymptomatic or only slightly symptomatic lesion may be debated, especially if the lesion is voluminous, since the risk associated with an intervention is not negligible, ranging from 3.7% to 66.6% of complications in the most recent series [4][5][6][7][8][9]. A study of the literature on significant TDH (>20% of the spinal canal) revealed a small number of case reports noting spontaneous resorption [10][11][12][13][14].…”