title: Transpedicular Approach to Thoracic Disc Herniaton Guided by 3D Navigation System.
abstract: The choice of surgical approach for thoracic disc herniation should consider the location on the axial plane and the consistency of the herniated disc. Calcified midline disc herniations are difficult to remove with a transpedicular approach because of limitations due to blind spots; so they are usually treated via a transthoracic approach, although this entails a high risk of thoracopulmonary injuries.
  
  
  
  In this work we present two cases of calcified midline thoracic disc herniations treated with a transpedicular approach, improved by using a three-dimensional (3D) neuronavigation system to verify the extent of removal on the blind side.
  
  
  
  Postoperative computed tomography (CT) scans demonstrated that this original technical innovation, in the two present cases, allowed us to reach the side opposite the disc herniation and to assess the extent of resection at the end of the procedure.
  
  
  
  The employment of a neuronavigation system in the transpedicular approach allowed safe and effective removal of calcified midline thoracic disc herniations. We did not observe any postoperative neurological worsening, onset of spinal instability, or other adverse events.
authors.affiliation: Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy.
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Innocenzi
authors.affiliation: Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy. manueladercolemd@gmail.com.
authors.forename: Manuela
authors.initials: M
authors.lastname: D'Ercole
authors.affiliation: Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cardarelli
authors.affiliation: Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Bistazzoni
authors.affiliation: Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ricciardi
authors.affiliation: Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marzetti
authors.affiliation: Department of Orthopaedics and Traumatology, University of Naples "Federico II", Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sasso
mesh_terms: D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D064795:Intraoperative Neurophysiological Monitoring; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D020335:Paraparesis / Q000209:etiology; D010292:Paresthesia / Q000209:etiology; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed
keywords: Spinal neuronavigation; Thoracic disc herniation; Thoracic transpedicular approach