Minimally invasive transpedicular approach for the treatment of central calcified thoracic disc disease

a technical note

Jonathan Nakhla, Niketh Bhashyam, Rafael de la Garza Ramos, Rani Nasser, Merritt D. Kinon, Reza Yassari

Research output: Contribution to journalArticle

Abstract

Purpose: To assess the utility of stereotactic navigation for the surgical treatment of ossified, paracentral thoracic discs via a minimally invasive (MI) transpedicular approach. Methods: The authors performed a retrospective review of cases with paracentral thoracic disc herniation resulting in myelopathy where a traditional MI approach would be difficult, who underwent a stereotactic assisted MI transpedicular approach via a tubular retractor system between 2011 and 2016. Five cases of patients over the age of 18 were selected. Collected data included patient age at surgery, sex, preoperative Nurick grade, number of levels treated, calcified disc presence, length of surgery, estimated blood loss (EBL), length of stay (LOS), complication rate, postoperative Nurick grade, and length of follow-up. Results: Five patients had a stereotaxic assisted MI transpedicular thoracic discectomy for paracentrally located calcified disc herniation. Intraoperative navigational images were acquired using intraoperative CT scans (O-arm) to plan and guide the surgical procedure, and real-time navigation was used for precise navigation around the cord to access and remove all fragments. MIS surgery was successfully performed in these otherwise contraindicated cases due to the use of intraoperative real-time stereotactic navigation. All patients had a successful decompression around the anterior aspect of the cord. Conclusion: The traditional MI transpedicular thoracic discectomy approach can be further refined and enhanced by stereotactic navigation to expand the limitations of the MIS technique allowing for an increased number and types of patients eligible for minimally invasive surgery. Therefore, MIS via a tubular retractor system with stereotactic navigation is a novel, safe, and effective improvement in feasibility from the traditional minimally invasive transpedicular thoracic discectomy technique.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalEuropean Spine Journal
DOIs
StateAccepted/In press - Dec 15 2017

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Thoracic Diseases
Thorax
Diskectomy
Therapeutics
Minimally Invasive Surgical Procedures
Spinal Cord Diseases
Decompression
Length of Stay

Keywords

  • Minimally invasive surgery
  • Outcome
  • Stereotactic navigation
  • Transpedicular thoracic discectomy
  • Tubular retractor

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Minimally invasive transpedicular approach for the treatment of central calcified thoracic disc disease : a technical note. / Nakhla, Jonathan; Bhashyam, Niketh; de la Garza Ramos, Rafael; Nasser, Rani; Kinon, Merritt D.; Yassari, Reza.

In: European Spine Journal, 15.12.2017, p. 1-11.

Research output: Contribution to journalArticle

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abstract = "Purpose: To assess the utility of stereotactic navigation for the surgical treatment of ossified, paracentral thoracic discs via a minimally invasive (MI) transpedicular approach. Methods: The authors performed a retrospective review of cases with paracentral thoracic disc herniation resulting in myelopathy where a traditional MI approach would be difficult, who underwent a stereotactic assisted MI transpedicular approach via a tubular retractor system between 2011 and 2016. Five cases of patients over the age of 18 were selected. Collected data included patient age at surgery, sex, preoperative Nurick grade, number of levels treated, calcified disc presence, length of surgery, estimated blood loss (EBL), length of stay (LOS), complication rate, postoperative Nurick grade, and length of follow-up. Results: Five patients had a stereotaxic assisted MI transpedicular thoracic discectomy for paracentrally located calcified disc herniation. Intraoperative navigational images were acquired using intraoperative CT scans (O-arm) to plan and guide the surgical procedure, and real-time navigation was used for precise navigation around the cord to access and remove all fragments. MIS surgery was successfully performed in these otherwise contraindicated cases due to the use of intraoperative real-time stereotactic navigation. All patients had a successful decompression around the anterior aspect of the cord. Conclusion: The traditional MI transpedicular thoracic discectomy approach can be further refined and enhanced by stereotactic navigation to expand the limitations of the MIS technique allowing for an increased number and types of patients eligible for minimally invasive surgery. Therefore, MIS via a tubular retractor system with stereotactic navigation is a novel, safe, and effective improvement in feasibility from the traditional minimally invasive transpedicular thoracic discectomy technique.",
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