J Korean Neurosurg Soc.  2014 Jun;55(6):383-386. 10.3340/jkns.2014.55.6.383.

Ultrasound-Guided Posterolateral Approach for Midline Calcified Thoracic Disc Herniation

• Tan LA
• Lopes DK
• Fontes RB

• KMID: 2191123
• DOI: http://doi.org/10.3340/jkns.2014.55.6.383

Abstract

OBJECTIVE
Symptomatic thoracic disc herniation often requires prompt surgical treatment to prevent neurological deterioration and permanent deficits. Anterior approaches offer direct visualization and access to the herniated disc and anterior dura but require access surgeons and are often associated with considerable postoperative pain and pulmonary complications. A disadvantage with using posterior approaches in the setting of central calcified thoracic disc herniation however, has been the limited visualization of anterior dura and difficulty to accurately assess the extent of decompression.
METHODS
We report our experience with intraoperative ultrasound (US) guidance during a modified posterior transpedicular approach for removal of a central calcified thoracic disc herniation with a review of pertinent literature.
RESULTS
The herniated thoracic disc was successfully removed with posterior approach with the aid of intraoperative US. The patient had significant neurological improvement at three months follow-up.
CONCLUSION
Intraoperative ultrasound is a simple yet valuable tool for real-time imaging during transpedicular thoracic discectomy. Visualization provided by intraoperative US increases the safety profile of posterior approaches and may make thoracotomy unnecessary in a selected group of patients, especially when a patient has existing pulmonary disease or is otherwise not medically fit for the transthoracic approach.

Keyword

Calcified disc; Discectomy; Intraoperative ultrasound; Thoracic disc herniation; Transpedicular

MeSH Terms

Decompression
Diskectomy
Follow-Up Studies
Humans
Intervertebral Disc Displacement
Lung Diseases
Pain, Postoperative
Thoracotomy
Ultrasonography

Figure

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  Fig. 1 Preoperative CT (A and B) and MR (C and D) demonstrate a large, calcified, midline disc herniation at T7-8 with significant cord signal change.

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  Fig. 2 Intraoperative coronal (A) and sagittal (B) US images demonstrate a large anterior disc herniation causing cord deformation. Fragments of the calcified thoracic disc herniation (C) are pushed down into the vertebral body cavity and removed piecemeal through a left transpedicular approach without contacting the dura until US guidance (D and E) demonstrate effective cord decompression. r : right side, ro : rostral, US : ultrasound.

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  Fig. 3 Postoperative sagittal (A) and axial (B) CT with ample decompression of the spinal cord. T8 vertebral body defect is estimated at 10% of its total volume.

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