Neurosurgery Fellow University of California San Francisco
Disclosure(s):
Nathan Han, MD: No financial relationships to disclose
Introduction: Giant calcified thoracic disk (GCTD) herniations present significant challenges to successful resection due to their size, location, and adherence to the ventral dura. Several different surgical methods have been utilized; however, each method encompasses disadvantages that can increase the risk of surgery or provide suboptimal window for safe resection. In this technical case study, we highlight a single position transpedicular-transdural approach that provides safe, efficient, and maximal resection of GCTD herniation.
Methods: This is a technical case study approaching complex giant calcified thoracic disk herniation through single position transpedicular-transdural approach. A 61-year-old female presented with back pain, incontinence, and gait instability. CT myelogram of the thoracic spine showed 1.7cm central, calcified disk herniation at T7-8 with severe cord compression. A transpedicular approach with partial T8 corpectomy was performed to undermine the calcified disk. The posterior dura was then opened and disk was removed utilizing the corpectomy defect. Ventral dural defect was directly repaired, dorsal dural opening was closed, and pedicle screws were inserted followed by rods.
Results: Post operative CT myelogram demonstrated successful resection GCTD with decompression of spinal cord. There was no postoperative neurologic deficit, CSF leak, or other complications. Patient was discharged post-operative day five and demonstrated improvement in myelopathic symptoms at one year follow up.
Conclusion : Transpedicular-transdural approach takes advantage of the corridor provided by transpedicular approach to safely undermine the calcified disk, allows direct visualization of thoracic cord during disk resection to minimize cord injury and provide easy access for ventral dural repair all performed in single prone position. Transpedicular-transdural approach may provide a safe, efficient, and optimal surgical option to address GCTD herniations.
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