Neurological deterioration after posterior decompression of an unrecognised calcified thoracic disc: recovery following endoscopic discectomy

Abstract

Calcified thoracic disc herniation is uncommon but carries substantial operative risk. A 67-year-old man with 12 months of progressive myelopathy from a T7-T8 disc herniation underwent posterior laminectomy and instrumented fusion without preoperative computed tomography (CT). He developed near-complete paraplegia, with lower-limb power of Medical Research Council grade 0–1/5. Subsequent CT demonstrated a densely calcified ventral disc. Following transfer, full-endoscopic transforaminal discectomy was performed to address the ventral compression without spinal cord retraction. By three months after the revision procedure, power improved to grade 4–4+/5 and he regained ambulation using a walking frame. Thoracic disc herniations being considered for surgery should be characterised with CT as well as magnetic resonance imaging. Calcified lesions warrant subspecialty review and an approach that directly addresses the ventral pathology. In selected patients, endoscopic discectomy may achieve effective decompression with limited access morbidity.