18. Intraoperative monitoring in calcified giant thoracic disc herniations in anterior thoracic approach surgery

Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): C. Minardi, F. Cultrera, M. Bocchino, G. Pugliese, G. Fedeli, R. Donati
Giant herniated thoracic disc (GHTD) is a surgical challenge with high rate of complication. This was a retrospective study of all patients with calcified GHTD operated between July 2012 and February 2017 with intraoperative neurophysiological monitoring (IOM).The study included 10 patients (9 females and 1 male).IOM study comprised: transcranial electric motor evoked potentials (MEP) and somatosensory evoked potentials (SEP) from all limbs in supine position and after lateral position.IOM MEP at the end of surgery were reduced in 4 recovered in 1, stable in 5 patients and disappeared at left lower limb in 1 patient.IOM SEP were stable in 6 patients, reduced in amplitude in 2, disappeared in 1 and in 1 case SEP at lower limbs were absent from preoperative study.The neurological outcome was stable in 9 and transitory worsened in 1 patient, who lost MEP in lower left limb.The surgical strategy was modified according to IOM findings in 4 cases leading to a partial disc excision, one where IOM MEP disappeared and 3 where MEP decreased without recovering.IOM is usefull in this combined surgery (thoracic surgery and neurosurgery) and can help to remove safely GHDT without new permanent neurological deficits.



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