A Modified Eggshell Technique for Sclerosing Thoracic Disc Herniation

Summary

This protocol introduces a modified eggshell surgical technique used for treating sclerosing thoracic disc herniation.

Abstract

Sclerosing thoracic disc herniation refers to a condition in which the intervertebral disc in the thoracic region protrudes and becomes calcified, causing compression on the spinal cord and/or nerve roots. Sclerosing herniation of the thoracic disc poses a significant danger as it can lead to serious complications like paraplegia during or after surgery. Iatrogenic spinal cord injury is a common risk for individuals diagnosed with sclerosing thoracic disc herniation due to the inflexible protrusion of the sclerosing disc into the spinal canal and its adhesion to the ventral side of the dural sac. The challenging and crucial aspect of the surgery is how to safely and efficiently eliminate the hardened tissue. The eggshell method is a surgical procedure that addresses the kyphosis abnormality of the spinal column by excavating the vertebral body via the pedicles and subsequently inserting the kyphotic fracture block into the excavated vertebral body. In this article, a revised surgical method using the eggshell technique will be presented for the treatment of sclerosing thoracic disc herniation. The surgical procedure briefly involves hollowing out the anterior intervertebral space of the hardened disc tissue to create an eggshell-like structure, with the sclerotic tissue forming the posterior wall. Subsequently, the sclerotic disc tissue is pushed into the hollow intervertebral space to achieve complete decompression of the ventral spinal cord. The safety and effectiveness of this approach for treating sclerosing thoracic disc herniation have been confirmed.

Introduction

In medical situations, thoracic disc herniation is categorized into three types: central, paracentral, and lateral. Spinal cord injury (SCI) symptoms are predominant in central protrusion, whereas radicular symptoms are commonly observed in lateral protrusion. Central and paracentral protrusions account for approximately 70%. Predominant segments affected are T11 and T12 (26%), with 75% of thoracic disc herniation occurring between T8 and T12, and the subsequent thoracic vertebrae exhibiting the highest incidence^1,2,3.

When nerve compression occurs....

Protocol

This protocol has received approval and adheres to the guidelines established by The Ethics Committee of Hebei Medical University Third Hospital. Patient data were collected after obtaining informed consent from them. The inclusion criteria for patients were as follows: patients suffering from symptoms of spinal cord damage with ineffective conservative treatment, the presence of hardened tissue observed on X-ray, computer tomography (CT), and magnetic resonance imaging (MRI) on the ventral side of the spinal cord, and complete clinical data with regular follow-ups. Patients with coexisting contraindications such as infection or tumor, or those unable to tolerate the ....

Results

As reported in our previous study²⁰, the modified eggshell surgery was successfully performed on 25 patients. The sclerotic tissues of four patients were extensively adhered to the dural sac, making it impossible to fully remove the tissues. However, the compression force on the spinal cord caused by the anterior sclerotic tissue was completely relieved. In two patients, dural sac rupture occurred due to the intraoperative separation of sclerotic tissue and the dural sac, but CSF leakage stopped a.......

Discussion

The primary application of this surgical procedure is to achieve thorough decompression of the spinal cord from all angles, utilizing the posterior pathway of the thoracic spine. Serious complications are common in patients with thoracic disc herniation, primarily due to the anatomy of the thoracic spine. According to Min et al.¹⁸, anterior decompression using an anterior method has a definite impact but requires a challenging procedure. Furthermore, the extensive trauma it induces, substantial di.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Bipolar electrocoagulation tweezers	Juan'en Medical Devices Co.Ltd	BZN-Q-B-S	1.2 mm x 190 mm
Bone wax	ETHICON	W810T	2.5 g
Curette	Qingniu	20739.01	300 x Ø9 x 5°
Curette	Qingniu	20739.02	300 x Ø9 x 15°
Curette	Qingniu	20739.03	300 x Ø9 x 30°
Curette	Qingniu	20739.04	300 x Ø9 x 45°
Double jointed forceps	SHINVA	286920	240 mm x 8 mm
High frequency active electrodes	ZhongBangTianCheng	GD-BZ	GD-BZ-J1
Laminectomy rongeur	Qingniu	2054.03	220 x 3.0 x 130°
Pedicle screw	WEGO	800386545	6.5 mm x 45 mm
Pedicle screw	WEGO	800386550	6.5 mm x 50 mm
Rod	WEGO	800386040	5.5 mm x 500 mm