Paolini Sergio, Tola Serena, Missori Paolo, Esposito Vincenzo, Cantore Giampaolo
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy-IRCCS Neuromed, Via Atinense, 18-86077, Pozzilli, IS, Italy.
Department of Neurosurgery, Sapienza University of Rome, Italy-IRCCS Neuromed, Pozzilli, Italy.
Eur Spine J. 2016 Jan;25(1):200-206. doi: 10.1007/s00586-015-3858-5. Epub 2015 Mar 12.
Resection of calcified thoracic disc herniations carries significant risks of neurological worsening, particularly in case of concomitant central location. Transthoracic approaches are a first-choice option to avoid spinal cord manipulation but entail drawbacks such as postoperative pain and the risk of bronchopulmonary complications. The purpose of this report is to describe a novel approach to resect calcified herniations, even centrally located, from a posterior perspective.
Unilateral lamino-arthrectomy is performed, uncovering few millimeters of the disc space beside the dura. Following discectomy and drilling of the vertebral endplates, an angled endoscope is introduced allowing resection of the calcified herniation through an anterior perspective. The spinal cord can now be decompressed with a no-touch technique. Each maneuver aimed at resecting the calcified mass up to the contralateral side can be done under visual control.
The technique was used in two patients. The first was a 38-year-old man with a calcified mediolateral T9-T10 disc herniation and mild myelopathic symptoms. The second patient was a 73-year-old obese woman, with a T6-T7 central, calcified disc herniation and severe compression myelopathy. In both cases, complete decompression of the spinal cord could be achieved and rapid neurological recovery was observed postoperatively. No surgery-related complications were observed.
The endoscope-assisted posterior approach afforded safe and complete resection of calcified discs. The technique is particularly useful for central disc herniations, where transthoracic approaches are normally deemed mandatory.
切除钙化性胸椎间盘突出症具有神经功能恶化的重大风险，尤其是在合并中央型病变的情况下。经胸入路是避免脊髓操作的首选方案，但存在术后疼痛和支气管肺部并发症风险等缺点。本报告的目的是描述一种从后方视角切除钙化性突出物（即使是中央型）的新方法。
进行单侧椎板关节突切除术，在硬脊膜旁暴露几毫米的椎间盘间隙。在椎间盘切除术和椎体终板钻孔后，引入成角内窥镜，通过前方视角切除钙化性突出物。现在可以采用非接触技术对脊髓进行减压。旨在切除钙化肿块直至对侧的每一步操作都可在视觉控制下完成。
该技术应用于两名患者。首例为一名38岁男性，患有T9 - T10钙化性中外侧椎间盘突出症及轻度脊髓病症状。第二例患者是一名73岁肥胖女性，患有T6 - T7中央型钙化椎间盘突出症及严重压迫性脊髓病。在这两例中，均实现了脊髓的完全减压，术后观察到神经功能迅速恢复。未观察到与手术相关的并发症。
内窥镜辅助后入路能安全、完整地切除钙化椎间盘。该技术对于中央型椎间盘突出症尤其有用，而经胸入路通常被认为是必要的。
