Introduction: To report a novel paradigm for resection of the disc or dura complex to treat giant, calcified, transdural, herniated thoracic discs and to present a technique for repair of dural defects. These herniated thoracic discs are uncommon complicated lesions often requiring a multidisciplinary team for effective treatment. The intradural component must be removed to effectively decompress the spinal cord. The opening of the friable dura, which is frequently adherent to the extradural component of the disc, can result in large defects and difficult-to-manage cerebrospinal fluid leaks.
Methods: Retrospective study reporting on the technique and outcomes in cases of transdural herniated discs treated at our institution from 2012 to 2015.
Results: Seven patients (mean age, 56.1 years) presented to our service with clinical symptoms consistent with myeloradiculopathy during the study period. In all cases, 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, Bridgewater, NJ) graft was sewn to close the pleural defect. Every patient had a lumbar drain for cerebrospinal fluid diversion perioperatively. No patient suffered neurological decline related to the surgery, and 3 patients had clinically significant improvement in function. Two patients developed early postoperative cerebrospinal fluid leaks requiring operative revision to oversew the defects.
Conclusions: This novel technique for decompression of the spinal cord by dural resection for 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.
Patient Care: Adds to the literature a technical approach to treating these extremely difficult large, midline, calficified, transdural thoracic disc hernations, and presents our institutions experience with this approach.
Learning Objectives: 1. Understand the limitations of current surgical approaches in treating giant, calcified, transdural herniated thoracic discs
2. Learn a novel anterior approach that involves circumferential resection of the disc, and measures taken to reduce the risk of CSF-pleural fistula formation