Transdural Ventral Sling Technique for Calcified Thoracic Disk Herniations

Abstract

BackgroundSurgery for thoracic disc herniations remains an ongoing challenge, with a variety of surgical approaches, all with their own inherent risks. Discectomy via a posterior laminectomy was historically the treatment of choice; however, it was deemed very high risk with elevated rates of neurologic injury. The posterior transdural approach is an alternative surgical option for soft and calcified thoracic disc herniations. ObjectiveTo present a surgical technique to remove a calcified thoracic disc herniation without entry into the thoracic cavity. MethodsA 56-year-old female presented with many years of numbness/tingling in her hands and difficulty with fine motor tasks but developed progressive weakness and loss of balance in her legs. Imaging revealed a prominent focal central calcified disc herniation at the T5-T6 level causing severe effacement and distortion of the spinal cord. A posterior transdural approach for direct visualization of a large, calcified disc herniation was performed to remove the calcified disc herniation without the need for extensive surgical exposure or entry into the thoracic cavity. A ventral sling of the dura was created to allow rotation of the spinal cord while removing the calcified disc. Preoperative and postoperative radiographic assessments were conducted to evaluate the effectiveness of the approach. ConclusionsThe transdural approach is less invasive in nature, minimizes surgical exposure, patient morbidity, and provides better intraoperative control of the spinal cord. This constitutes an effective alternative surgical approach to both soft and calcified central thoracic disc herniations.