Transpedicular Transdural Approach for Calcified Thoracic Disc Herniations: Technical Commentary, Case Series and Review of the Literature

Background/Objectives:Calcified thoracic disc herniations are a formidable surgical challenge due to their proximity to the spinal cord and the heightened risk of iatrogenic neurological injury. Traditional anterior and posterolateral approaches, while effective in select scenarios, may not provide adequate exposure for large, centrally located calcified discs.. Methods:We conducted a retrospective case series of seven patients who underwent transpedicular-transdural thoracic discectomy for central or centrolateral calcified disc herniations at our institution over the past years. All patients were followed clinically for a minimum of three months postoperatively. Surgical technique and intraoperative nuances were also documented. Results: The transdural approach enabled direct access to the ventral thoracic spine, allowing for effective decompression of calcified herniations in all cases. No major intraoperative complications were reported, and all patients demonstrated clinical improvement or neurological stability at three-month follow-up. Technical aspects of the microsurgical approach were critical to minimizing risk.Conclusions: The transpedicular-transdural approach is a viable and effective surgical option for select cases of central or centrolateral calcified thoracic disc herniation. When executed with precise microsurgical technique, it offers safe decompression with favorable short-term outcomes.