Surgical Treatment of Calcified Thoracic Herniated Disc Disease via the Transthoracic Approach with the Use of Intraoperative Computed Tomography (iCT) and Microscope-Based Augmented Reality (AR)
Background and Objectives: The aim of this study is to present our experience in the surgical treatment of calcified thoracic herniated disc disease via a transthoracic approach in the lateral position with the use of intraoperative computed tomography (iCT) and augmented reality (AR). Materials...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Philipps-Universität Marburg
2024
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| Subjects: | |
| Online Access: | PDF Full Text |
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| Summary: | Background and Objectives: The aim of this study is to present our experience in the surgical
treatment of calcified thoracic herniated disc disease via a transthoracic approach in the lateral
position with the use of intraoperative computed tomography (iCT) and augmented reality (AR).
Materials and Methods: All patients who underwent surgery for calcified thoracic herniated disc via a
transthoracic transpleural approach at our Department using iCT and microscope-based AR were
included in the study. Results: Six consecutive patients (five female, median age 53.2 ± 6.4 years) with
calcified herniated thoracic discs (two patients Th 10–11 level, two patients Th 7–8, one patient Th
9–10, one patient Th 11–12) were included in this case series. Indication for surgery included evidence
of a calcified thoracic disc on magnet resonance imaging (MRI) and CT with spinal canal stenosis of
>50% of diameter, intractable pain, and neurological deficits, as well as MRI-signs of myelopathy. Five
patients had paraparesis and ataxia, and one patient had no deficit. All surgeries were performed in
the lateral position via a transthoracic transpleural approach (Five from left side). CT for automatic
registration was performed following the placement of the reference array, with a high registration
accuracy. Microscope-based AR was used, with segmented structures of interest such as vertebral
bodies, disc space, herniated disc, and dural sac. Mean operative time was 277.5 ± 156 min. The use
of AR improved orientation in the operative field for identification, and tailored the resection of the
herniated disc and the identification of the course of dural sac. A control-iCT scan confirmed the
complete resection in five patients and incomplete resection of the herniated disc in one patient. In
one patient, complications occurred, such as postoperative hematoma, and wound healing deficit
occurred. Mean follow-up was 22.9 ± 16.5 months. Five patients improved following surgery, and one
patient who had no deficits remained unchanged. Conclusions: Optimal surgical therapy in patients
with calcified thoracic disc disease with compression of dural sac and myelopathy was resectioned via
a transthoracic transpleural approach. The use of iCT-based registration and microscope-based AR
significantly improved orientation in the operative field and facilitated safe resection of these lesions. |
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| Item Description: | Gefördert durch den Open-Access-Publikationsfonds der UB Marburg. |
| Physical Description: | 18 Pages |
| DOI: | 10.3390/medicina60060887 |