Giant calcified thoracic disk herniations: ossification of PLL or autonomous entity?

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Journal of neurosurgical sciences Pub Date : 2024-02-01 Epub Date: 2020-07-29 DOI:10.23736/S0390-5616.20.04938-3
Giuseppe D'Aliberti, Fabio Villa, Pietro Giorgi, Francesco M Crisà, Giulia Gribaudi, Lara Mastino, Anna M Auricchio, Marco Cenzato, Giuseppe Talamonti
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引用次数: 0

Abstract

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 case 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.

巨型钙化胸椎椎间盘突出症:PLL 的骨化还是独立实体?
背景:巨型钙化胸椎椎间盘突出症(GCTD)并不常见,需要手术治疗的患者不到 1%。巨型钙化性胸椎椎间盘突出症是胸椎椎间盘突出症的一个特殊亚群,其钙化程度与一定程度的骨化有关,占椎管的 40% 以上。在本文中,我们报告了通过前路手术治疗 GCTD 的全部经验。我们认为,这些椎管后纵韧带骨化症(OPLL)的特征与硬脊膜侵犯可能构成的共同病理生理学有关:方法:1996-2019年间,意大利米兰Niguarda医院连续对23例GCDT患者进行了前路治疗。回顾了临床数据、放射学特征、手术报告、组织学发现和结果:无死亡病例,永久性发病包括1例意外脊髓挫伤导致的截瘫恶化。一名患者需要再次手术以修复术后脑脊液(CSF)漏。所有患者术后都接受了磁共振成像检查,结果显示所有病例的脊髓和硬膜囊都得到了很好的减压。组织学研究显示,整体切除的GCTD具有典型的PLL钙化模式:结论:GCDT 可归类于所谓的 "环状型 "OPLL。结论:GCDTs 可被归类为所谓的 "周界型 "OPLL,GCDTs 可显示出与 OPLL 相同的放射 CT 和 MRI 模式。目前,前入路是治疗 GCTD 的标准方法。必须使用手术显微镜并进行术中监测。通过精心重建硬脑膜和放置脊髓引流管,可显著降低 CSF 渗漏的风险。为了充分暴露,有时可能需要进行一到两层的椎间盘切除术,然后重建椎体并固定脊柱前柱。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of neurosurgical sciences
Journal of neurosurgical sciences CLINICAL NEUROLOGY-SURGERY
CiteScore
3.00
自引率
5.30%
发文量
202
审稿时长
>12 weeks
期刊介绍: The Journal of Neurosurgical Sciences publishes scientific papers on neurosurgery and related subjects (electroencephalography, neurophysiology, neurochemistry, neuropathology, stereotaxy, neuroanatomy, neuroradiology, etc.). Manuscripts may be submitted in the form of ditorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work.
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