Posterior transdural resection of giant calcified thoracic disc herniation in a case series of 12 patients
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ORIGINAL ARTICLE
Posterior transdural resection of giant calcified thoracic disc herniation in a case series of 12 patients Chiara Negwer 1 & Vicki M. Butenschoen 1
&
Sandro M. Krieg 1 & Bernhard Meyer 1
Received: 18 July 2020 / Revised: 17 September 2020 / Accepted: 5 October 2020 # The Author(s) 2020
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. Keywords Transdural surgery . Giant thoracic disc herniation
Introduction Thoracic disc herniations remain an uncommon cause for compression of the spinal cord and symptoms of myelopathy Chiara Negwer and Vicki M. Butenschoen contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10143-020-01413-0) contains supplementary material, which is available to authorized users. * Vicki M. Butenschoen [email protected] Chiara Negwer [email protected] Sandro M. Krieg [email protected] Bernhard Meyer [email protected] 1
Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str 22, 81675 Munich, Germany
[1–4]. Compared with cervical and lumbar disc herniations, the calcification rate has been reported to be 30–70% [5], which contributes to the complexity of surgery removal. Several surgical approaches have been proposed to perform a resection in symptomatic patients, including the transthoracic approach [6–8], posterior costotransversectomy [9], and transpedicular approaches [10]. The optimal treatment remains a matter of debate [11, 12], and complications such as spinal instability, cerebrospinal fluid (CSF) leakage, and pleural fistulas are described [13]. In 2012, Coppes et al. introduced a case series of 13 patients operated on, with a novel technique for cen
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