A Novel Surgical Technique for Management of Giant Central Calcified Thoracic Disk Herniations: A Dual Corridor Method Involving Tubular Transthoracic/Retropleural Approach Followed by a Posterior Transdural Diskectomy

Abstract

Background: Thoracic disk herniations (TDHs) represent only 0.15% to 1.8% of surgically managed disk herniations but have posed a particular challenge to spine surgeons. Numerous surgical approaches have been cited in the literature with varying degrees of success, technical complexity, and complication profiles.

Objective: To report a case of a combined lateral retropleural and dorsal transdural approach for complex thoracic discectomy.

Methods: In this report, we describe a combined lateral/retropleural and posterior transdural approach for a patient with a giant calcified TDH that was not amenable to safe removal using a single approach.

Results: In complex situations such as this, a dual corridor approach allows for improved visualization and maximal resection opportunity and opens up yet another option to address recalcitrant TDH.

Conclusion: The staged dual corridor approach is safe and represents a further surgical option for extremely difficult TDH.

Keywords: Giant thoracic disk herniation; Surgical rib fixation; calcified; dual corridor; minimally invasive; retropleural; salvage; thoracic spine surgery; transdural; transthoracic.