首页|Surgical management of giant calcified thoracic disc herniation and the role of neuromonitoring. The outcome of large mono centric series
Surgical management of giant calcified thoracic disc herniation and the role of neuromonitoring. The outcome of large mono centric series
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NSTL
Elsevier
? 2022 Elsevier LtdPurpose: Giant thoracic disc herniations (GTDH) are considered a subgroup of TDHs with worse functional outcomes, a high calcification rate, and a considerable risk of complications. We aimed to determine whether there is a relationship between the extent of calcification of GTDH and outcomes concerning the risk of complications, the surgical technique, and changes in neuromonitoring signals. Methods: We present a retrospective analysis of 76 patients undergoing surgery for calcific GTDH. We introduced and defined a radiological definition of the calcified disc into “fully calcified” and “partially calcified.” We performed a statistical analysis between clinical and radiological variables, type of surgical procedure, the extent of excision, neuro-monitoring signals, and outcome, comparing a group of 58 “fully-calcified TDH” patients and 18 “partially-calcified TDH” patients. Results: Fully calcified TDHs, compared with partially calcified TDHs, do not have significant differences in outcome (worse outcome 4/58–6.9% versus 0/18, p = 0.25) and complications (10/58–17.24% versus 4/18–22.2%, p = 0.63); Fully calcified TDH is associated with a higher risk of alterations in neurophysiological potentials (14/58–24.1% versus 0/18, p = 0.02) and subtotal excision (18/58–31% versus 2/18–11%, p = 0.15), without significant differences between the approaches used. Conclusion: Fully calcified TDH group has a similar outcome and complication rate as the partially calcified TDH group, but they are associated with higher intraoperative neuromonitoring signal changes. We introduced a new classification system that guides the approach and helps to counsel the patients.
NSTL
Elsevier
