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Calcified thoracic herniation

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
Sergio Paolini, Serena Tola, Paolo Missori, Vincenzo Esposito, Giampaolo Cantore
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...
January 2016: European Spine Journal
Lee A Tan, Demetrius K Lopes, Ricardo B V Fontes
OBJECTIVE: Symptomatic thoracic disc herniation often requires prompt surgical treatment to prevent neurological deterioration and permanent deficits. Anterior approaches offer direct visualization and access to the herniated disc and anterior dura but require access surgeons and are often associated with considerable postoperative pain and pulmonary complications. A disadvantage with using posterior approaches in the setting of central calcified thoracic disc herniation however, has been the limited visualization of anterior dura and difficulty to accurately assess the extent of decompression...
June 2014: Journal of Korean Neurosurgical Society
Yusuke Nishimura, Nova B Thani, Satoru Tochigi, Henry Ahn, Howard J Ginsberg
OBJECT: Symptomatic thoracic disc herniations (TDHs) are relatively uncommon, and the technical challenges of resecting the offending disc are formidable due to the location of spinal cord that has relatively poor perfusion characteristics within a narrow canal. The majority of disc herniations are long-standing calcified discs that can be adherent to the ventral dura. Real-time intraoperative ultrasound (RIOUS) visualization of the spinal cord during the retraction and resection of the disc greatly enhances the safety and efficacy of disc resection...
October 2014: Journal of Neurosurgery. Spine
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 in order 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...
June 5, 2014: Journal of Spinal Disorders & Techniques
Erwin M J Cornips
STUDY DESIGN: Retrospective analysis of a prospectively collected database of thoracoscopic microdiscectomies performed at the Maastricht University Medical Center. OBJECTIVE: Many victims of a motor vehicle collision (MVC) report crippling upper back pain resistant to conservative treatment. Although this pain is often regarded as nonspecific or related to a whiplash type of cervical spine injury, this study demonstrates it may be caused by a thoracic disc herniation...
May 20, 2014: Spine
N A Quraishi, A Khurana, M M Tsegaye, B M Boszczyk, S M H Mehdian
INTRODUCTION: Giant herniated thoracic discs (GHTD) remain a surgical challenge. When combined with calcification, these discs require altered surgical strategies and have only been infrequently described. Our objective was to describe our surgical approaches in the management of calcified GHTD. METHODS: This was a retrospective cohort study of all patients with calcified GHTD operated between 2004 and 2012. Data were collected from review of patients' notes and radiographs and included basic demographic and radiological data, clinical presentation and outcome, operative procedure and complications...
April 2014: European Spine Journal
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