Giant calcified thoracic disk herniations: ossification of PLL or autonomous entity?
| Autor: | Lara Mastino, Giulia Gribaudi, Marco Cenzato, Giuseppe D'Aliberti, Giuseppe Talamonti, Fabio Villa, Pietro Domenico Giorgi, Francesco M Crisà, Anna Maria Auricchio |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cord Decompression Ossification business.industry medicine.medical_treatment medicine.disease Surgery medicine.anatomical_structure Cerebrospinal fluid medicine Posterior longitudinal ligament Spinal canal Neurology (clinical) Corpectomy medicine.symptom business Calcification |
| Zdroj: | Journal of Neurosurgical Sciences. |
| ISSN: | 1827-1855 |
| DOI: | 10.23736/s0390-5616.20.04938-3 |
| Popis: | Background Giant calcified thoracic disk herniation (GCTD) is an uncommon event, which requires surgical treatment in less than 1% of patients. GCDTs are a specific subgroup of herniated thoracic disks occupying more than 40% of the spinal canal showing calcifications associated with a certain degree of ossification. In this paper, we are reporting our whole experience in the surgical management of GCTDs through anterior approaches. We believe that they present characteristics that associate them to the circumscribed type of Ossified Posterior Longitudinal Ligament (OPLL) with a possible common pathophysiology consisting in the dural violation. Methods Twenty-three consecutive patients with GCDTs were managed through anterior approaches during the period 1996-2019 at the Niguarda Hospital - Milan, Italy. Clinical data, radiological features, surgical reports, histological findings, and outcomes were reviewed. Results There was no mortality, whereas permanent morbidity consisted of 1 cases of worsened paraparesis due to accidental spinal cord contusion. One patient required reoperation to repair a postoperative cerebrospinal fluid (CSF) leakage. All patients underwent postoperative MRI which showed excellent decompression of cord and dural sac in all cases. Histological study of en-bloc removed GCTD showed typical calcification patterns of the PLL. Conclusions GCDTs may be assimilated to the so-called "circumscribed type" of OPLL. The GCDTs may show the same radiological CT and MRI pattern of OPLL. The anterior accesses now represent the standard of care for GCTDs. The use of operative microscope and intraoperative monitoring is mandatory. The risk of CSF leakage can be markedly reduced by meticulous reconstruction of the dura and the placement of spinal drainage. Adequate exposition may sometimes require one or two levels of corpectomy with consequent vertebral body reconstruction and fixation of anterior column of the spine. |
| Databáze: | OpenAIRE |
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