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Transthoracic approach for the treatment of calcified giant herniated thoracic discs
Yongfei Zhao1, Yan Wang, Songhua Xiao
1Department of Orthopedics, The General Hospital of Chinese People's Liberation Army (301 Hospital), 28 Fuxing Road, Beijing, 100853, China, lakezyf@hotmail.com.
Insights
The transthoracic approach effectively treats calcified giant herniated thoracic discs (HTDs), improving patient symptoms and neurological function with minimal complications. This surgical technique offers a safe and effective solution for complex spinal conditions.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Thoracic Surgery
Background:
- Calcified giant herniated thoracic discs (HTDs) present significant surgical challenges.
- Transthoracic approaches are considered for managing these complex spinal pathologies.
Purpose of the Study:
- To report the outcomes of a transthoracic approach for treating calcified giant HTDs.
- To evaluate the safety and efficacy of this surgical technique.
Main Methods:
- Retrospective analysis of 15 patients with calcified giant HTDs.
- Transthoracic decompression, segmental instrumentation, and interbody fusion were performed.
- Pre- and postoperative clinical data, including Frankel grades and JOA scores, were assessed.
Main Results:
- Successful disc removal in all patients without complications like dural tears.
- Significant improvement in Frankel grades and JOA scores postoperatively.
- All patients reported symptom improvement, with a mean follow-up of 45 months.
Conclusions:
- Transthoracic decompression with reconstruction, fusion, and fixation is an effective treatment for calcified giant HTDs.
- The procedure is associated with low rates of complications, morbidity, and neurological impairment.
- This approach offers a viable surgical option for complex thoracic disc herniations.
Objective:
This study aimed at reporting the results of a transthoracic approach in the treatment of patients with calcified giant herniated thoracic discs (HTDs).
Methods:
Fifteen consecutive patients, 11 males and 4 females with a mean age of 46 years (range 33-61), with calcified giant HTDs underwent transthoracic decompression and segmental instrumentation with interbody fusion from November 2004 to September 2010. Clinical data retrospectively examined and compared were levels and types of disc herniation, operative time, blood loss, pre- and postoperative Frankel grades and Japanese Orthopedic Association (JOA) score, and complications.
Results:
Of the 15 patients, 2 had HTDs at two levels and affected discs were primarily at the T11/12 level (60%). Presenting symptoms included myelopathy, axial back pain, urinary symptoms, and radiculopathy. Disc herniations were classified as central (40%) or paracentral (60%). All discs were successfully removed without dural tears or cerebral spinal fluid leakage. The mean operation time was 179 ± 27 min (range 140-210 min), and the mean estimated blood loss was 840 ± 470 ml (range 300-2,000 ml). Frankel grades improved in 9 patients postoperatively and 12 patients at the last follow-up. The mean JOA score improved from 4.9 to 7.7. All patients reported improvement in symptoms. The average duration of follow-up was 45 ± 24 months (range 7-77 months).
Conclusions:
Transthoracic decompression combined with reconstruction, fusion, and fixation is an effective method for the treatment of these lesions and is associated with a low rate of complications, morbidity, and neurological impairment.
