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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C. y de la Sociedad Iberolatinoamericana de Columna. SILACO.

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Scielo

2026, Number 3

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Cir Columna 2026; 4 (3)

360° extracavitary approach for giant calcified thoracic disc herniation, assisted by navigation and endoscopy

Martínez SJA, Del VRR

Language: Spanish
References: 20
Page: 186-192
PDF size: 1946.53 Kb.


ABSTRACT

Introduction: symptomatic thoracic disc herniation (TDH) is an uncommon condition, accounting for approximately 0.1-5% of all disc herniations, and is often diagnosed late. Clinical presentation varies, ranging from thoracic pain and radicular symptoms to signs of myelopathy, including bowel and bladder dysfunction. Giant thoracic disc herniations (GTDH), defined as those occupying more than 40% of the spinal canal, are frequently associated with calcifications, increasing the risk of intraoperative complications such as dural injury and cerebrospinal fluid (CSF) leakage. Objective: to present a minimally invasive surgical technique using a combined approach (posterior conventional and lateral extracavitary tubular assisted by endoscopy) as a safe and effective alternative for the treatment of calcified GTDH, minimizing ventral dural sac manipulation. Material and methods: we report the case of a 50-year-old female with thoracic myelopathy secondary to a calcified GTDH at T9-T10. A microdiscectomy was performed using a 360° extracavitary approach assisted by navigation and endoscopy. Results: postoperatively, the patient presented with transient motor deficit, showing functional recovery within 48 hours. She was discharged after 72 hours and enrolled in a rehabilitation protocol. At 8-month follow-up, the patient demonstrated significant neurological improvement, with 4/5 muscle strength in the lower extremities, preserved sensation, and no sphincter involvement. Conclusion: the combined approach is an effective option for managing GTDH, enabling complete decompression with minimal dural sac manipulation. This technique optimizes clinical outcomes by reducing morbidity and represents a viable alternative in centers with appropriate experience and technology.


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