Long-term operative outcome of giant calcified thoracic disc herniation - A retrospective analysis of 24 patients.

ABSTRACT

Background: Thoracic disc herniations (TDHs) are rare (0.15-4%) and often cause significant myelopathy (70-95%). They are defined as "Giant" if they occupy >40% of the spinal canal. Further, they are ossified/calcified in 42% of cases, with a 70% incidence of intradural extension. Here, we reviewed our experience resecting 24 giant thoracic discs utilizing a posterolateral surgical approach. Methods: Over a 2-year period, we evaluated the outcomes for 24 patients averaging 40 years of age undergoing posterolateral resections of giant ossified/calcified TDH. We evaluated multiple clinical and radiographic parameters; demographics, Frankel grades, surgical time, perioperative complications, and number of levels involved. In addition, utilizing magnetic resonance/computed tomography studies, we documented that the most commonly involved level was T11-T12, and the average canal occupancy ratio (i.e., degree of canal encroachment) was 58.2 ± 7.72%. Results: Neurological improvement was seen in 22 of the 24 patients; none experienced neurological deterioration over the average 2-year post-operative period. Six complications occurred; three dural tears and three suture site infections. Conclusion: The posterolateral approach proved to be safe and effectively for resecting 24 giant ossified/calcified TDH with minimum complications.