Giant calcified thoracic herniated disc: considerations aiming a proper surgical strategy

Giant herniated thoracic disc (HTD) is a rare disease that, unlike other thoracic disc herniations of different size, need a different surgical management. The copresence of ''giant'' volume and calcification of the herniated disc heavily affects the surgical difficulty and is not elsewhere described.

Seven cases of surgically treated giant calcified HTDs were considered in this study. Five of them were females and two males, age range 18-63 years. Before and after surgery, all patients underwent computed tomography myelography, magnetic resonance imaging or both pre-and postoperatively. Functional outcomes were assessed using the Asia grading system preoperatively, immediately after surgery, and at long-term follow-up examination. The mean overall follow-up period was 36 months. All patients presented with various grades of myelopathy: according to the Asia impairment scale, two were grade B, four were grade C and one were grade D. Six patients underwent an anterior approach, i.e. thoracotomy, and one patients underwent a posterolateral approach, i.e. peduncolocostotrasversectomy.

Based on an analysis of the long-term follow-up data, the Asia grade improved in five patients (71.4%), stabilized (no grade change) in one (14.3%), and worsened in one (14.3%).

Giant calcified HTDs are particularly challenging surgical lesions and their volume and consistency are additional elements of difficulty. This article presents authors' personal experience on a small but extraordinary series of giant and calcified thoracic herniated discs and the problems encountered in the management of this peculiar pathology since an accurate surgical planning leads to better clinical results.