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Endoscope-assisted resection of calcified thoracic disc herniations

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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.

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Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy-IRCCS Neuromed, Via Atinense, 18-86077, Pozzilli, IS, Italy

    Sergio Paolini

  2. Department of Neurosurgery, Sapienza University of Rome, Italy-IRCCS Neuromed, Pozzilli, Italy

    Serena Tola, Vincenzo Esposito & Giampaolo Cantore

  3. Department of Neurology and Psychiatry, Sapienza University of Rome, Pozzilli, Italy

    Paolo Missori

Authors
  1. Sergio Paolini
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  2. Serena Tola
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  3. Paolo Missori
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  4. Vincenzo Esposito
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  5. Giampaolo Cantore
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Corresponding author

Correspondence to Sergio Paolini.

Additional information

Prof. Giampaolo Cantore: Deceased.

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Paolini, S., Tola, S., Missori, P. et al. Endoscope-assisted resection of calcified thoracic disc herniations. Eur Spine J 25, 200–206 (2016). https://doi.org/10.1007/s00586-015-3858-5

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  • DOI: https://doi.org/10.1007/s00586-015-3858-5

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