Surgery for Giant Calcified Herniated Thoracic Discs: A Systematic Review

OBJECTIVE: The giant calcified herniated thoracic disc ( HTD), a rare disease, is a challenge for surgeons because of its complications. This review aimed to confirm the surgical treatment, including surgical approach, results, and complications of HTDs. METHODS: This systematic review of the literature complies with the PRISMA guidelines and involves a search of PubMed, Embase, and the Cochrane Library for all papers describing surgical treatment of giant calcified HTDs in >= 3 patients. Data on the surgical approach, change in neurologic impairment, and complications were extracted from the search results. RESULTS: A total of 11 studies, including 164 patients with giant calcified HTDs that met the inclusion criteria, were included in this systematic review. Of the 164 patients, 145 had myelopathy in giant calcified HTDs, and 8 surgical approaches were included. After the surgical treatment, the neurologic grades were improved in 69% of patients, remained unchanged in 22% of patients, and worsened further in 3% of patients at the final follow-up. Also, of the total patients analyzed, 3% had permanent neurologic deterioration, 4% patients had subarachnoide-pleural cerebrospinal fluid fistula complications, 30% had other complications, 4% had reoperation via transthoracic approach, 13% had permanent neurologic deterioration via the posterolateral approach, and 25% had permanent neurologic deterioration via the thoracoscopy approach. CONCLUSIONS: Surgical treatment can improve or stabilize neurologic impairment for most patients with giant calcified HTDs. We thus recommend the anterior thoracotomy approach for giant calcified HTDs because of the theoretical advantages over other approaches and the low rate of neurologic deterioration, subarachnoide-pleural cerebrospinal fluid fistula, and reoperation.