Management of massive calcified transdural thoracic disk herniation

• Published in: Journal of clinical neuroscience 2003-11, Vol.10 (6), p.707-710
• Main Authors: Al-Barbarawi, Mohammed, Sekhon, Lali H.S.
• Format: Article
• Language: English
• Subjects: Back Pain - etiology; Biological and medical sciences; Calcified disc; Calcinosis - diagnostic imaging; Calcinosis - pathology; Calcinosis - surgery; Cerebrospinal fluid; Decompression, Surgical - methods; Diseases of the osteoarticular system; Diseases of the spine; Diskectomy; Dura Mater - diagnostic imaging; Dura Mater - pathology; Dura Mater - surgery; Dural tear; Female; Humans; Intervertebral Disc - diagnostic imaging; Intervertebral Disc - pathology; Intervertebral Disc - surgery; Intervertebral Disc Displacement - diagnostic imaging; Intervertebral Disc Displacement - pathology; Intervertebral Disc Displacement - surgery; Medical sciences; Middle Aged; Muscle, Skeletal - transplantation; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Prostheses and Implants; Radiography; Sciatica - etiology; Spinal Canal - diagnostic imaging; Spinal Canal - pathology; Spinal Canal - surgery; Spinal Cord Compression - etiology; Spinal Cord Compression - pathology; Spinal Cord Compression - surgery; Subarachnoid-pleural fistula; Subdural Effusion - etiology; Subdural Effusion - physiopathology; Subdural Effusion - prevention & control; Thoracic disc herniation; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - pathology; Thoracic Vertebrae - surgery; Thoracotomy; Transplants; Treatment Outcome; Tumors of striated muscle and skeleton
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2003.02.001

Thoracic disc herniation is a not uncommon pathology faced by the spinal surgeon. The management of massive intradural thoracic disc herniation with ventral cord compression is problematic both in terms of obtaining adequate decompression and ensuring no subsequent leakage of cerebrospinal fluid. A 54-year-old woman presented with a 10 year history of back pain and left leg pain. Over the past 6 months she experienced a progressive spastic paraparesis in both legs with recent urinary incontinence. A left anterolateral thoracotomy for excision of T8/9 thoracic disc protrusion was affected. A transdural decompression was performed with resection of the calcified dura and performance of a Gore-Tex duraplasty and pleuroplasty. A free muscle graft was placed in the intervening space and the chest drains were placed on non-suction. A spinal drain was maintained for 5 days. She made an excellent neurological recovery. Avoidance of cerebrospinal leakage is paramount when performing transthoracic approaches as negative intrapleural pressure can lead to persistence of leakage. This report documents a safe and reliable way to deal with massive intradural thoracic disc rupture with avoidance of subsequent spinal fluid leak.