title: Endoscope-assisted resection of calcified thoracic disc herniations.
abstract: OBJECTIVE
  Resection of calcified thoracic disc herniations carries significant risks of neurological worsening, particularly in case of concomitant central location. Transthoracic approaches are a first-choice option to avoid spinal cord manipulation but entail drawbacks such as postoperative pain and the risk of bronchopulmonary complications. The purpose of this report is to describe a novel approach to resect calcified herniations, even centrally located, from a posterior perspective.
  
  
  METHODS
  Unilateral lamino-arthrectomy is performed, uncovering few millimeters of the disc space beside the dura. Following discectomy and drilling of the vertebral endplates, an angled endoscope is introduced allowing resection of the calcified herniation through an anterior perspective. The spinal cord can now be decompressed with a no-touch technique. Each maneuver aimed at resecting the calcified mass up to the contralateral side can be done under visual control.
  
  
  RESULTS
  The technique was used in two patients. The first was a 38-year-old man with a calcified mediolateral T9-T10 disc herniation and mild myelopathic symptoms. The second patient was a 73-year-old obese woman, with a T6-T7 central, calcified disc herniation and severe compression myelopathy. In both cases, complete decompression of the spinal cord could be achieved and rapid neurological recovery was observed postoperatively. No surgery-related complications were observed.
  
  
  CONCLUSIONS
  The endoscope-assisted posterior approach afforded safe and complete resection of calcified discs. The technique is particularly useful for central disc herniations, where transthoracic approaches are normally deemed mandatory.
authors.affiliation: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy-IRCCS Neuromed, Via Atinense, 18-86077, Pozzilli, IS, Italy. srgpaolini@gmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Paolini
authors.affiliation: Department of Neurosurgery, Sapienza University of Rome, Italy-IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Tola
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Pozzilli, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Missori
authors.affiliation: Department of Neurosurgery, Sapienza University of Rome, Italy-IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Esposito
authors.affiliation: Department of Neurosurgery, Sapienza University of Rome, Italy-IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Cantore
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D017586:Diskectomy / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D007796:Laminectomy / Q000379:methods*; D008297:Male; D013904:Thoracic Vertebrae / Q000601:surgery*
keywords: Disc herniation; Endoscope; Myelopathy; Thoracic disc; Transfacet approach