Endoscope-assisted resection of calcified thoracic disc herniations

Sergio Paolini, Serena Tola, Paolo Missori, Vincenzo Esposito, Giampaolo Cantore

Research output: Contribution to journalArticle

Abstract

Purpose: Resection of calcified thoracic disc herniations carries significant risks of neurological worsening, particularly in case of concomitant central location. Transthoracic approaches are a first-choice option to avoid spinal cord manipulation but entail drawbacks such as postoperative pain and the risk of bronchopulmonary complications. The purpose of this report is to describe a novel approach to resect calcified herniations, even centrally located, from a posterior perspective. Methods: Unilateral lamino-arthrectomy is performed, uncovering few millimeters of the disc space beside the dura. Following discectomy and drilling of the vertebral endplates, an angled endoscope is introduced allowing resection of the calcified herniation through an anterior perspective. The spinal cord can now be decompressed with a no-touch technique. Each maneuver aimed at resecting the calcified mass up to the contralateral side can be done under visual control. Results: The technique was used in two patients. The first was a 38-year-old man with a calcified mediolateral T9–T10 disc herniation and mild myelopathic symptoms. The second patient was a 73-year-old obese woman, with a T6–T7 central, calcified disc herniation and severe compression myelopathy. In both cases, complete decompression of the spinal cord could be achieved and rapid neurological recovery was observed postoperatively. No surgery-related complications were observed. Conclusions: The endoscope-assisted posterior approach afforded safe and complete resection of calcified discs. The technique is particularly useful for central disc herniations, where transthoracic approaches are normally deemed mandatory.

Original languageEnglish
Pages (from-to)200-206
Number of pages7
JournalEuropean Spine Journal
Volume25
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Keywords

  • Disc herniation
  • Endoscope
  • Myelopathy
  • Thoracic disc
  • Transfacet approach

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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