Clinical and radiographic features of adult calcified thoracic disc herniation: a retrospective analysis of 31 cases

Lu, Yuan; Chen, Zhongqiang; Liu, Zhongjun; Li, Weishi; Sun, Chuiguo; Liu, Xiaoguang

doi:10.1007/s00586-023-07784-4

Cited by 1 publication

(4 citation statements)

References 24 publications

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“…Further factors which make the thoracic cord more vulnerable in case of a thoracic disc include a narrow spinal canal as well as the presence of the so-called “watershed zones”, which are areas of impaired blood supply [ 11 , 13 ]. Calcification of the nucleus pulposus in the intervertebral disc is the important radiological feature [ 3 ]. There are three types: calcium-ringed lesions, heterogeneous calcification lesions, and homogeneous calcification lesions [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Calcification of the nucleus pulposus in the intervertebral disc is the important radiological feature [ 3 ]. There are three types: calcium-ringed lesions, heterogeneous calcification lesions, and homogeneous calcification lesions [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…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 [ …”

Section: Discussionmentioning

confidence: 99%

“…However, a risk of damage to the lungs, pleura, and major vessels exists [ 1 ]. Large size and ossification and calcification of the thoracic discs make the treatment challenging, with further limitations being the scarce literature on the subject, which relies mostly on retrospective studies or small case series [ 3 ]. Technical challenges of the surgical treatment include the location of the disc, calcification and ossification with a restricted overview of the ventral cord, and characteristic blood supply to the thoracic cord [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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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)

Pojskić,

Bopp,

Nimsky

et al. 2024

Medicina

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Background and Objectives: The aim of this study is to present our experience in the surgical treatment of calcified thoracic herniated disc disease via a transthoracic approach in the lateral position with the use of intraoperative computed tomography (iCT) and augmented reality (AR). Materials and Methods: All patients who underwent surgery for calcified thoracic herniated disc via a transthoracic transpleural approach at our Department using iCT and microscope-based AR were included in the study. Results: Six consecutive patients (five female, median age 53.2 ± 6.4 years) with calcified herniated thoracic discs (two patients Th 10–11 level, two patients Th 7–8, one patient Th 9–10, one patient Th 11–12) were included in this case series. Indication for surgery included evidence of a calcified thoracic disc on magnet resonance imaging (MRI) and CT with spinal canal stenosis of >50% of diameter, intractable pain, and neurological deficits, as well as MRI-signs of myelopathy. Five patients had paraparesis and ataxia, and one patient had no deficit. All surgeries were performed in the lateral position via a transthoracic transpleural approach (Five from left side). CT for automatic registration was performed following the placement of the reference array, with a high registration accuracy. Microscope-based AR was used, with segmented structures of interest such as vertebral bodies, disc space, herniated disc, and dural sac. Mean operative time was 277.5 ± 156 min. The use of AR improved orientation in the operative field for identification, and tailored the resection of the herniated disc and the identification of the course of dural sac. A control-iCT scan confirmed the complete resection in five patients and incomplete resection of the herniated disc in one patient. In one patient, complications occurred, such as postoperative hematoma, and wound healing deficit occurred. Mean follow-up was 22.9 ± 16.5 months. Five patients improved following surgery, and one patient who had no deficits remained unchanged. Conclusions: Optimal surgical therapy in patients with calcified thoracic disc disease with compression of dural sac and myelopathy was resectioned via a transthoracic transpleural approach. The use of iCT-based registration and microscope-based AR significantly improved orientation in the operative field and facilitated safe resection of these lesions.

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