Outpatient endoscopic resection of large calcified thoracic disc herniation with caudal displacement.

Sanjay Konakondla,Sean M Barber,Jonathan R Slotkin,Nelson Sofoluke,Sarah A Rimini

doi:10.3171/2021.10.focvid2112

Sanjay Konakondla, Sean M Barber + Show 3 more

Open Access

https://doi.org/10.3171/2021.10.focvid2112

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Abstract

Thoracic disc herniations can cause radiculopathy and myelopathy from neural compression. Surgical resection may require complex, morbid approaches. To avoid spinal cord retraction, wide exposures requiring extensive tissue, muscle, and bony disruption are needed, which may require instrumentation. Anterior approaches may require vascular surgeons, chest tube placement, and intensive care admission. Large, calcified discs or migrated fragments can pose additional challenges. Previous literature has noted the endoscopic approach to be contraindicated for calcified thoracic discs. The authors describe an ultra–minimally invasive, ambulatory endoscopic approach to resect a large calcified thoracic disc with caudal migration and avoidance of conventional approaches.The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID2112

Highlights

Introduction and IndicationsThe patient is a 32-year-old female, BMI 54, who was suffering from 6 months of midthoracic back pain, progressive gait abnormalities, heaviness, and weakness in the legs
In a typical endoscopic transforaminal approach, the guide needle is docked on the posterior superior apex of the inferior vertebral body and just medial to the ipsilateral pedicle.[2]
Due to the large calcified caudal migration of this disc, it would have not been helpful to dock in this area, so we proceeded with a modified transforaminal approach

Summary

Introduction

Introduction and IndicationsThe patient is a 32-year-old female, BMI 54, who was suffering from 6 months of midthoracic back pain, progressive gait abnormalities, heaviness, and weakness in the legs. Imaging included an MRI and subsequently a CT of the thoracic spine which showed a large, calcified disc at the level of T9–10, preferential to the right side with caudal migration and significant spinal cord compression. To appreciate the intraoperative view and anticipate the amount of bony resection necessary, 3D models were digitally reconstructed from the patient’s CT scans and MRI.

Results

Conclusion