Circumferential dural resection technique and reconstruction for the removal of giant calcified transdural herniated thoracic discs

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OBJECTIVE

The authors report a novel paradigm for resection of the disc or dural complex to treat giant calcified transdural herniated thoracic discs, and they describe a technique for the repair of dural defects. These herniated thoracic discs are uncommon, complicated lesions that often require a multidisciplinary team for effective treatment. The intradural component must be removed to effectively decompress the spinal cord. The opening of the friable dura mater, which frequently adheres to the extradural component of the disc, can result in large defects and difficult-to-manage CSF leaks.

METHODS

The authors performed a retrospective study of the technique and outcomes in patients with a transdural herniated disc treated at St. Joseph’s Hospital and Medical Center within a 4-year period between 2012 and 2015.

RESULTS

During the study period, 7 patients (mean age 56.1 years) presented to the department of neurosurgery with clinical symptoms consistent with myeloradiculopathy. In all cases, 2-level corpectomies of the involved levels were combined with circumferential resection of the dura and complete decompression of the spinal cord. The dural defect was repaired with an onlay dural patch, and a large piece of AlloDerm (LifeCell Corp) graft was sewn to close the pleural defect. Every patient had a perioperative lumbar drain placed for CSF diversion. No patient suffered neurological decline related to the surgery, and 3 patients experienced clinically significant improvement in function. Two patients developed an early postoperative CSF leak that required operative revision to oversew the defects.

CONCLUSIONS

This novel technique for decompression of the spinal cord by dural resection for the removal of giant calcified transdural herniated thoracic discs is safe and results in excellent decompression of the spinal cord. The technique becomes necessary when primary repair of the dura is not possible, and it can be used in cases in which the resection of pathology includes the dura.

Article Information

Correspondence Nicholas Theodore, c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W Thomas Rd., Phoenix, AZ 85013. email: neuropub@dignityhealth.org.

INCLUDE WHEN CITING Published online December 1, 2017; DOI: 10.3171/2017.5.SPINE161285.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    A and B: Sagittal (A) and axial (B) T2-weighted MR images reveal an anterior compressive pathology effacing the spinal cord at T6–7 and smaller areas of disc herniation at other thoracic levels. C and D: Sagittal (C) and axial (D) CT images reveal a disc or osteophyte complex obliterating more than 50% of the spinal canal at the level of T6–7, with myelographic block. A giant calcified transdural disc was found intraoperatively to be compressing the spinal cord. E: The disc or osteophyte complex was resected circumferentially and removed. F: After the fusion was completed, a large piece of AlloDerm was sewn to the pleura to cover the site of the dural defect and to prevent egress of CSF into the pleural cavity. G: Intraoperative photograph of the graft-sewing process. Figure is available in color online only.

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