Surgery for Giant Calcified Herniated Thoracic Discs: A Systematic Review

Area of Science:

• Neurosurgery
• Spinal Surgery
• Thoracic Surgery

Background:

• Giant calcified herniated thoracic discs (HTDs) present significant surgical challenges due to potential complications.
• Effective surgical strategies for HTDs are crucial for managing patient outcomes.

Purpose of the Study:

• To review and confirm the efficacy of surgical treatments for giant calcified HTDs.
• To analyze surgical approaches, outcomes, and complications associated with HTDs.

Main Methods:

• A systematic literature review adhering to PRISMA guidelines.
• Searched PubMed, Embase, and Cochrane Library for studies on surgical treatment of giant calcified HTDs.
• Extracted data on surgical approach, neurologic changes, and complications from 11 studies involving 164 patients.

Main Results:

• Surgical treatment improved neurologic grades in 69% of patients with giant calcified HTDs.
• The anterior thoracotomy approach demonstrated a lower rate of permanent neurologic deterioration (13%) compared to posterolateral (13%) and thoracoscopy (25%) approaches.
• Complications included permanent neurologic deterioration (3%), cerebrospinal fluid fistula (4%), and reoperation (4% with transthoracic approach).

Conclusions:

• Surgical intervention is effective in improving or stabilizing neurologic function for most patients with giant calcified HTDs.
• The anterior thoracotomy approach is recommended for giant calcified HTDs, offering theoretical advantages and a lower risk of complications.
• This approach is associated with reduced rates of neurologic deterioration, cerebrospinal fluid fistula, and reoperation.