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Purpose <p>Though rare, thoracic disc herniation (TDH) can lead to debilitating myelopathy and poses considerable surgical challenges. The consistency of the herniated disc—soft versus calcified—may significantly influence surgical planning and perioperative outcomes. This retrospective study compares clinical features, surgical parameters, and neurological outcomes in patients with calcified versus soft TDH.</p> Methods <p>Thirty-six patients with thoracic myelopathy due to TDH were treated at a tertiary spine centre between 2018 and 2024. Patients were stratified into calcified (<i>n</i> = 20) and soft (<i>n</i> = 16) disc cohorts based on imaging and intraoperative findings. Data included demographics, imaging, operative details, and neurological outcomes. A p-value &lt; 0.05 was considered significant.</p> Results <p>Baseline demographics were comparable. Calcified cases had higher blood loss (450 mL vs. 275 mL, <i>p</i> = 0.027), more IONM alerts (33% vs. 0%, <i>p</i> = 0.02), and a trend toward more postoperative deficits. Long-term neurological outcomes were comparable (35% vs. 31% improved, <i>p</i> = 0.40).</p> Conclusion <p>Calcified TDHs are associated with greater surgical complexity and risk. However, with appropriate planning, long-term outcomes match those of soft discs. Disc morphology should inform intraoperative strategy but does not necessarily predict prognosis.</p>

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Does disc consistency matter? a comparative series on calcified and soft thoracic disc herniations

  • 期刊论文

  • 发表日期：

    2025年6月18日

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  • Chinedu Egu,
  • P.S. Ratnayake,
  • I.M. Alrabi,
  • N.S. Jayalath,
  • Neel Badhe,
  • Eduardo Muscogliati,
  • Weronika Nocun,
  • N.A. Quraishi,
  • Elie Najjar

摘要

Purpose

Though rare, thoracic disc herniation (TDH) can lead to debilitating myelopathy and poses considerable surgical challenges. The consistency of the herniated disc—soft versus calcified—may significantly influence surgical planning and perioperative outcomes. This retrospective study compares clinical features, surgical parameters, and neurological outcomes in patients with calcified versus soft TDH.

Methods

Thirty-six patients with thoracic myelopathy due to TDH were treated at a tertiary spine centre between 2018 and 2024. Patients were stratified into calcified (n = 20) and soft (n = 16) disc cohorts based on imaging and intraoperative findings. Data included demographics, imaging, operative details, and neurological outcomes. A p-value < 0.05 was considered significant.

Results

Baseline demographics were comparable. Calcified cases had higher blood loss (450 mL vs. 275 mL, p = 0.027), more IONM alerts (33% vs. 0%, p = 0.02), and a trend toward more postoperative deficits. Long-term neurological outcomes were comparable (35% vs. 31% improved, p = 0.40).

Conclusion

Calcified TDHs are associated with greater surgical complexity and risk. However, with appropriate planning, long-term outcomes match those of soft discs. Disc morphology should inform intraoperative strategy but does not necessarily predict prognosis.