1
|
LeRoy TE, Ruiz-Cardozo MA, Molina CA. Transdural Ventral Sling Technique for Calcified Thoracic Disk Herniations. World Neurosurg 2024; 183:123-127. [PMID: 38104932 DOI: 10.1016/j.wneu.2023.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Surgery for thoracic disc herniations remains an ongoing challenge, with numerous surgical approaches, all with their own inherent risks. Discectomy via a posterior laminectomy was historically the treatment of choice; however, it was deemed very high risk with elevated rates of neurologic injury. The posterior transdural approach is an alternative surgical option for soft and calcified thoracic disc herniations. METHODS A 56-year-old female with many years of numbness/tingling in her hands and difficulty with fine motor tasks presented with progressive weakness and loss of balance in her legs. Imaging revealed a prominent focal central calcified disc herniation at the T5-T6 level causing severe effacement and distortion of the spinal cord. A posterior transdural approach for direct visualization of a large calcified disc herniation was performed, removing the calcified disc without the need for extensive exposure or entry into the thoracic cavity. A ventral sling of the dura was created to allow rotation of the spinal cord while removing the disc. RESULTS Intraoperative ultrasound confirmed complete disc resection, restoring cerebral spinal fluid flow circumferentially without residual impingement or cerebrospinal fluid leaks. At six months postsurgery, the patient's gait imbalance had resolved, and she had full lower extremity strength (5/5). Radiographic evaluation indicated stable implants without subsidence, pullout, fracture, or alignment loss. CONCLUSIONS The transdural approach is less invasive in nature, minimizes surgical exposure, patient morbidity, and provides better intraoperative control of the spinal cord. This constitutes an effective alternative surgical approach to both soft and calcified central thoracic disc herniations.
Collapse
Affiliation(s)
- Taryn E LeRoy
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts, USA
| | - Miguel A Ruiz-Cardozo
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Camilo A Molina
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
| |
Collapse
|
2
|
Mandelli C, Spina A, Calvanese F, Mortini P. How I do it: posterior transdural approach for central soft thoracic disk herniation. Acta Neurochir (Wien) 2020; 162:2051-4. [PMID: 32385640 DOI: 10.1007/s00701-020-04387-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Thoracic disc herniation (TDH) is a rare condition with severe neurological sequelae. Surgical management is still a matter of debate and challenging. METHOD We present a modification of the transdural approach for TDH. The approach has been described in a stepwise fashion, analysing pre-, peri-, and postoperative strategies to improve patients' management and reduce approach-related morbidity. CONCLUSION The modified posterior transdural approach represents an effective technique for TDH, minimizing the risk of spinal cord damages, which can dramatically affect the outcome.
Collapse
|
3
|
Tang W, Shao T, Guan F, Zhang Z, Gao Q, Guan G, Hu Y, Sun W, Fu G, Li G, Gu J, Yu Z. Transdural Approach to Resection of Intraspinal Extradural Ventral Cysts in the Lumbar Spine. World Neurosurg 2020; 140:347-352. [PMID: 32434012 DOI: 10.1016/j.wneu.2020.05.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraspinal extradural ventral cysts in the lumbar spine can cause back pain and neurological deficits of the lower extremities. For the resection of this type of space-occupying lesion, the transdural approach has not been reported in the literature. CASE DESCRIPTION A 66-year-old man presented, suffering from progressive radiation pain of his bilateral lower extremities. Imaging examination revealed a cystic lesion in ventral side of lumbar spinal canal. We conducted the excision of the cyst with the transdural approach. The symptoms of the patient disappeared immediately after the operation and recurrence of the symptoms has not been observed in the 3-month follow-up. CONCLUSIONS This operation approach is safe and effective. Compared with the previous surgical approach reported in the literature, by this approach surgeons could achieve less injury, shorter operation time, and the same surgical outcomes in the short term. Therefore, we would like to present this approach to provide an alternative to deal with similar lesions.
Collapse
Affiliation(s)
- Weilong Tang
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tuo Shao
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fulin Guan
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhizhuang Zhang
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qichang Gao
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guofa Guan
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuhang Hu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wencheng Sun
- The Hulunbuir Second People's Hospital, Hulunbuir, China
| | - Guomin Fu
- Moqi People's Hospital, Hulunbuir, China
| | - Guozhong Li
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiaao Gu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Zhange Yu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
4
|
Schomacher M, Jiang F, Alrjoub M, Witiw CD, Diamandis P, Fehlings MG. The posterior cervical transdural approach for retro-odontoid mass pseudotumor resection: report of three cases and discussion of the current literature. Eur Spine J 2020; 29:162-170. [PMID: 32296950 DOI: 10.1007/s00586-020-06405-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 03/02/2020] [Accepted: 03/30/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The treatment of a retro-odontoid pseudotumor mass associated with severe spinal cord compression is challenging due to the complex regional anatomy. Here, we present an attractive treatment option involving a single-stage posterior transdural microsurgical resection followed by instrumented cervical reconstruction. METHODS We describe three patients presenting with clinical signs of cervical myelopathy and an imaging finding of mucoid and fibrous soft or semi-soft retro-odontoid pseudotumor mass with significant spinal cord compression at the C1/C2 level. Given the severity of the symptoms, surgical decompression was planned and fusion was necessitated by the severe degenerative osteoarthritis seen at the C1/C2 level with signs of instability. Using a standard posterior approach to the spine, a suboccipital decompression by craniectomy and laminectomy of C1, C2 and C3 was performed. The masses were visualized and confirmed with ultrasound imaging, and intraoperative neurosurgical monitoring was applied. The dura was then opened from the level of C0-C2. Exiting C2-C3 nerve roots were identified and protected throughout the procedure, and the dentate ligament was cut to facilitate access. Incision of the anterior dura provided easy access to the lesion for resection without any spinal cord retraction. Multiple intraoperative samples were sent to pathology for tissue diagnosis. The dura was closed with sutures and an overlay of fibrin sealant with collagen matrix sponge. The fusion procedures were performed using a standard occipital cervical plate and screws technique with contoured titanium rods. CONCLUSIONS The posterior cervical transdural approach is a safe alternative procedure for mucoid and fibrous soft or semi-soft retro-odontoid pseudotumor mass removal. Preoperative CT scan can evaluate tissue characteristics and distinguish between a soft or ossified mass in front of the spinal cord. Local anatomical conditions facilitate less bleeding and adhesions, together with less spinal cord traction, in the intradural space. Cranio-cervical and suboccipital stabilization can be easily and safely performed with this exposure.
Collapse
Affiliation(s)
- M Schomacher
- Vivantes Neurochirurgie, Klinikum Neukoelln, Rudower Str. 48, 12351, Berlin, Germany
| | - F Jiang
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - M Alrjoub
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - C D Witiw
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - P Diamandis
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - M G Fehlings
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. .,Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada.
| |
Collapse
|
5
|
Abstract
BACKGROUND Intradural disc herniation is a rare phenomenon in spine surgery. Diagnosis is difficult despite current neuroradiologic imaging techniques. METHOD We present a case of a 59-year-old man with lumbar and radicular pain and a recurrent lumbar herniation. A laminectomy was performed after no clear disc herniation in the epidural space was found and an intradural mass was palpable. A durotomy showed an intradural disc fragment that was removed, followed by an arthrodesis. CONCLUSION Only intraoperative findings lead to a definitive diagnosis for intradural herniation. A durotomy needs to be performed. In this case, an arthrodesis was necessary to avoid complications of segmental instability.
Collapse
Affiliation(s)
- Víctor Rodrigo
- Department of Neurosurgery, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, 50009, Zaragoza, Spain.
| | - Marta Claramonte
- Department of Neurosurgery, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, 50009, Zaragoza, Spain
| | - Mónica Martín
- Department of Neurosurgery, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, 50009, Zaragoza, Spain
| | - Juan B Calatayud
- Department of Neurosurgery, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, 50009, Zaragoza, Spain
| |
Collapse
|