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Calcified thoracic herniation

Hayley Oligane, Jean Rongo, Vikas Agarwal, Barton F Branstetter
Although spontaneous regression of herniated disk material has been reported in the lumbar and cervical spine, reports of complete spontaneous regression of calcified thoracic disk herniations are exceedingly rare. In symptomatic patients, surgery is typically the treatment of choice; however, conservative therapy with surveillance may allow time for spontaneous resolution and potentially avoid high-risk surgery. We report a 40-year-old woman with complete spontaneous resolution of a large calcified thoracic disk extrusion with conservative management over an 8-month period...
February 13, 2018: Skeletal Radiology
Jonathan Nakhla, Niketh Bhashyam, Rafael De la Garza Ramos, Rani Nasser, Merritt D Kinon, Reza Yassari
PURPOSE: To assess the utility of stereotactic navigation for the surgical treatment of ossified, paracentral thoracic discs via a minimally invasive (MI) transpedicular approach. METHODS: The authors performed a retrospective review of cases with paracentral thoracic disc herniation resulting in myelopathy where a traditional MI approach would be difficult, who underwent a stereotactic assisted MI transpedicular approach via a tubular retractor system between 2011 and 2016...
December 15, 2017: European Spine Journal
C Court, E Mansour, C Bouthors
Thoracic disc herniation is rare and mainly occurs between T8 and L1. The herniation is calcified in 40% of cases and is labeled as giant when it occupies more than 40% of the spinal canal. A surgical procedure is indicated when the patient has severe back pain, stubborn intercostal neuralgia or neurological deficits. Selection of the surgical approach is essential. Mid-line calcified hernias are approached from a transthoracic incision, while lateralized soft hernias can be approached from a posterolateral incision...
February 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Corey T Walker, M Yashar S Kalani, Mark E Oppenlander, Jakub Godzik, Nikolay L Martirosyan, Robert J Standerfer, Nicholas Theodore
OBJECTIVE The authors report a novel paradigm for resection of the disc or dural complex to treat giant calcified transdural herniated thoracic discs, and they describe a technique for the repair of dural defects. These herniated thoracic discs are uncommon, complicated lesions that often require a multidisciplinary team for effective treatment. The intradural component must be removed to effectively decompress the spinal cord. The opening of the friable dura mater, which frequently adheres to the extradural component of the disc, can result in large defects and difficult-to-manage CSF leaks...
February 2018: Journal of Neurosurgery. Spine
Ahmed-Ramadan Sadek, Christopher Dare, Stephen McGillion, Ali Nader-Sepahi, Vasileios Skiadas
Calcific discitis is a well recognized entity in the paediatric population but more recently has been increasingly reported in adults. It typically involves the lower thoracic vertebrae and is of unknown aetiology. Herniation of the calcified fragment is rare but typically occurs out through the annulus fibrosus into the canal space. Herein we describe the first reported case of calcific discitis involving the lumbar vertebrae with subsequent herniation of the calcified disc into and through the anterior aspect of the L5 vertebra...
October 26, 2017: British Journal of Neurosurgery
Erwin M J Cornips
BACKGROUND: Anterior transthoracic approaches, including thoracoscopic microdiscectomy (TMD), are the preferred techniques for central, broad-based, calcified thoracic disc herniations (TDHs). Dural defects due to manipulation or transdural extension may create a potentially life-threatening subarachnoid-pleural fistula. We evaluate a fast, sutureless technique for reconstructing the dura. METHODS: We analyzed 476 anterior transthoracic approaches for TDHs (437 TMDs, 31 mini-thoracotomies, 7 transaxillary approaches, and 1 sternotomy)...
January 2018: World Neurosurgery
David Brauge, Rachid Madkouri, Vincent Reina, Saad Bennis, Bertrand Baussart, Etienne Mireau, Sorin Aldea, Stephan Gaillard
BACKGROUND: Acute myelopathy in cases of thoracic disc herniation (TDH) is an exceptional condition for which the treatment is not codified. Here we present the results of a standardized procedure in 10 patients who underwent surgery for acute myelopathy on TDH between December 2009 and December 2016. METHODS: Our approach began with a cautious laminectomy without resection of the hernia on the day of admission. On subsequent days, a complementary thoracoscopic procedure was performed according to the patient's neurologic recovery and the nature of the hernia (calcified or fibrous)...
November 2017: World Neurosurgery
Gualtiero Innocenzi, Manuela D'Ercole, Giovanni Cardarelli, Simona Bistazzoni, Francesco Ricciardi, Francesco Marzetti, Francesco Sasso
BACKGROUND: The choice of surgical approach for thoracic disc herniation should consider the location on the axial plane and the consistency of the herniated disc. Calcified midline disc herniations are difficult to remove with a transpedicular approach because of limitations due to blind spots; so they are usually treated via a transthoracic approach, although this entails a high risk of thoracopulmonary injuries. METHODS: In this work we present two cases of calcified midline thoracic disc herniations treated with a transpedicular approach, improved by using a three-dimensional (3D) neuronavigation system to verify the extent of removal on the blind side...
2017: Acta Neurochirurgica. Supplement
Hidayet Sari, Tugce Ozekli Misirlioglu, Deniz Palamar
There were only a few cases describing spontaneous regression of calcified thoracic disc herniation in the literature. We present a 38-year-old male office worker who had left paramedian-foraminal extruded disc at T7-T8 with calcifications of the T7-T8 and T8-T9 intervertebral discs. This case was unique in that the non-calcified extruded disc material regressed almost completely in 5 months while the calcified intervertebral discs remained the same during the process of regression. This report stresses that regression of the herniated material of the thoracic discs with subsidence of the symptoms is still possible even if the disc material is calcified...
December 2016: Acta Orthopaedica et Traumatologica Turcica
Rafid Al-Mahfoudh, Paul S Mitchell, Martin Wilby, Daniel Crooks, Chris Barrett, Robin Pillay, Tim Pigott
STUDY DESIGN: Case series and review of the literature. OBJECTIVE: To review the management of giant calcified disks in our large cohort and compare with the existing literature. We discuss our surgical technique. METHODS: Twenty-nine cases of herniated thoracic disk between 2000 and 2013 were reviewed. Eighteen patients were identified as having giant calcified thoracic disks, defined as diffusely calcified disks occupying at least 40% of the spinal canal...
September 2016: Global Spine Journal
Felix E Diehn, Timothy P Maus, Jonathan M Morris, Carrie M Carr, Amy L Kotsenas, Patrick H Luetmer, Vance T Lehman, Kent R Thielen, Ahmad Nassr, John T Wald
Beyond the familiar disk herniations with typical clinical features, intervertebral disk pathologic conditions can have a wide spectrum of imaging and clinical manifestations. The goal of this review is to illustrate and discuss unusual manifestations of intervertebral disk pathologic conditions that radiologists may encounter, including disk herniations in unusual locations, those with atypical imaging features, and those with uncommon pathophysiologic findings. Examples of atypical disk herniations presented include dorsal epidural, intradural, symptomatic thoracic (including giant calcified), extreme lateral (retroperitoneal), fluorine 18 fluorodeoxyglucose-avid, acute intravertebral (Schmorl node), and massive lumbar disk herniations...
May 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Mark E Oppenlander, Justin C Clark, James Kalyvas, Curtis A Dickman
STUDY DESIGN: Retrospective case series. OBJECTIVE: To identify the indications, techniques, and outcomes for instrumented fusion during thoracic discectomy. SUMMARY OF BACKGROUND DATA: Thoracic discectomy may require extensive bone removal to avoid spinal cord manipulation, but the indications and techniques for instrumented fusion during thoracic discectomy remain poorly delineated. METHODS: The authors identified 220 consecutive patients who underwent thoracic discectomy between 1992 and 2012...
March 2016: Clinical Spine Surgery
Faiz U Ahmad, Erica Schallert, Amade Bregy, Judith D Post, Steven Vanni
Regression of herniated disc fragments with subsequent improvement in clinical symptoms has been reported in the lumbar and cervical spine. Such regressions in the thoracic spine are extremely rare. We report a case of a 38-year-old patient with thalassaemia who had regression of a large calcified herniated thoracic disc causing cord compression, with subsequent herniation of a second calcified disc at a different level and discuss the possible aetiopathogenesis. This is the first such case reported in the thalassaemia population...
January 28, 2016: BMJ Case Reports
Nanfang Xu, Feng Wei, Xiaoguang Liu, Liang Jiang, Zhongjun Liu
PURPOSE: Calcific discitis is a self-limiting process most commonly seen in the cervical spine of children. Rare literature exists regarding the natural history and management of this condition in adults, especially when it presents as a giant thoracic disc herniation into the spinal canal. Giant herniations in the thoracic spine are typically surgically removed to reduce the chance of permanent neurologic deficit from spinal cord compression. However, when associated with calcific discitis, they may undergo spontaneous regression with the need for surgery obviated...
May 2016: European Spine Journal
Roland Roelz, Christoph Scholz, Jan-Helge Klingler, Christian Scheiwe, Ronen Sircar, Ulrich Hubbe
PURPOSE: Safe treatment of giant central thoracic disc herniations (cTDHs) remains a surgical challenge due to frequent calcifications, intradural extension and, importantly, the rare exposure of spine surgeons to these lesions. We report our 10-year experience in the management of giant cTDH by mini-thoracotomy and offer a detailed description of the technique. METHODS: 17 patients harboring 17 giant cTDH operated on via a mini-thoracotomy at the authors' institution between 2004 and 2014 were reviewed...
May 2016: European Spine Journal
Wouter I Schievink, Lindsey Ross, Ravi S Prasad, M Marcel Maya
BACKGROUND: Some patients with spontaneous intracranial hypotension have a ventral spinal cerebrospinal fluid (CSF) leak and these CSF leaks may be associated with calcified disk herniations. Identifying these calcifications is helpful in directing treatment. We report here the unusual case of a patient with a ventral CSF leak in whom the associated calcification absorbed over a five-month period. CASE REPORT: A 42-year-old woman developed orthostatic headaches and bilateral abducens nerve palsies...
December 2016: Cephalalgia: An International Journal of Headache
Qing-shan Zhuang, Deng-xing Lun, Zhao-wan Xu, Wei-hua Dai, Da-yong Liu
Few reports are available on the posterior transfacet approach for the treatment of central calcified thoracic disk herniation (TDH). The objective of this study was to assess outcomes and complications in a consecutive series of patients with TDH who underwent posterior transfacet decompression and diskectomy with segmental instrumentation and fusion. The data for 27 patients (16 males and 11 females) were retrospectively reviewed and analyzed, including clinical presentation, blood loss, operative time, pre- and postoperative complications, visual analog scale, Japanese Orthopedic Association (JOA) score, and Frankel grade...
September 2015: Orthopedics
Bin Yue, Bohua Chen, Yun-Wen Zou, Yong-Ming Xi, Xian-Feng Ren, Hong-Fei Xiang, You-Gu Hu, Guoqing Zhang
PURPOSE: Acute paraplegia due to thoracic intervertebral disc protrusion and calcification is rare. The purpose of this study was to report two cases with acute paraplegia due to a calcified thoracic disc prolapse, and discuss its clinical diagnosis and surgical treatment with literature reviews. METHODS: These two cases were verified by patient history, physical examination, laboratory examination, CT and MRI studies, and pathological findings. RESULTS: CT scan revealed disc calcification and protrusion at the T11-12 level in case 1 and at the T10-11 level in case 2, respectively...
May 2016: European Spine Journal
Katsuhito Yoshioka, Hideki Murakami, Satoru Demura, Satoshi Kato, Hiroyuki Tsuchiya
This study reports a case of severe anterior compression of the spinal cord by a calcified herniated thoracic disc at the T9/10 level in a 46-year-old woman. She underwent resection of the calcified herniated thoracic disc and the integrated dura, using a microscopically assisted mini-open transthoracic approach. The remaining dura mater was shaped and repaired by alternate overlapping without suture. The dural surface was reinforced with a combination of fibrin glue and a polyglycolic acid sheet. This novel procedure prevented postoperative cerebrospinal fluid leakage...
August 2015: Journal of Orthopaedic Surgery
Ali M Elhadi, Aqib H Zehri, Hasan A Zaidi, Kaith K Almefty, Mark C Preul, Nicholas Theodore, Curtis A Dickman
We aimed to determine the clinical indications and surgical outcomes for thoracoscopic discectomy. Thoracic disc disease is a rare degenerative process. Thoracoscopic approaches serve to minimize tissue injury during the approach, but critics argue that this comes at the cost of surgical efficacy. Current reports in the literature are limited to small institutional patient series. We systematically identified all English language articles on thoracoscopic discectomy with at least two patients, published from 1994 to 2013 on MEDLINE, Science Direct, and Google Scholar...
November 2015: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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