Transpedicular Transdural Approach for Calcified Thoracic Disc Herniations: Technical Commentary, Case Series, and Review of the Literature

TL;DR

A new surgical approach for calcified thoracic disc herniations is shown to be effective in decompressing the spinal cord with good short-term outcomes.

Contribution

The transpedicular–transdural approach is introduced as a viable surgical option for calcified thoracic disc herniations.

Findings

The transdural approach enabled successful decompression of calcified thoracic discs in all seven cases.

86% of patients showed clinical improvement or neurological stability after three months.

Precise microsurgical technique was critical to minimizing neurological risks during the procedure.

Abstract

Background/Objectives: Calcified thoracic disc herniations are a formidable surgical challenge due to their proximity to the spinal cord and the heightened risk of iatrogenic neurological injury. Traditional anterior and posterolateral approaches, while effective in select scenarios, may not provide adequate exposure for large, centrally located calcified discs. Methods: We performed a narrative review of the literature and retrospective case series of seven patients who underwent transpedicular–transdural thoracic discectomy for central or centrolateral calcified disc herniations at our institution in recent years. All patients were followed clinically for a minimum of three months postoperatively. Surgical technique and intraoperative nuances were also documented. Results: The transdural approach enabled direct access to the ventral thoracic spine, allowing for the effective decompression of calcified herniations in all cases. Six out of seven patients (86%) demonstrated clinical improvement or neurological stability at three-month follow-up, while one out of seven patients (14%) who presented with severe preoperative neurological deficits had persisting neurological deterioration postoperatively. The technical aspects of the microsurgical approach were critical to minimizing risk. Conclusions: The transpedicular–transdural approach is a viable and effective surgical option for select cases of central or centrolateral calcified thoracic disc herniation. When executed with a precise microsurgical technique, it offers safe decompression with favourable short-term outcomes.

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