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.
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.
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.
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.
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: email@example.com.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.
DickmanCA, MicanCA: Multilevel anterior thoracic discectomies and anterior interbody fusion using a microsurgical thoracoscopic approach. Case report. 84:104–109, 1996861381510.3171/jns.1996.84.1.0104)| false
KalaniMY, FilippidisA, MartirosyanNL, TheodoreN: Cerebral herniation as a complication of chest tube drainage of cerebrospinal fluid after injury to the spine. 79:798.E17–798.E19, 201310.1016/j.wneu.2011.04.028)| false
MazurMJostGFSchmidtMHBissonEF: Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature. Neurosurg Focus30(3):E132011
MazurM, JostGF, SchmidtMH, BissonEF: Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature. 30(3):E13, 20112136175110.3171/2010.12.FOCUS10255)| false