Combined Transdural and Transpedicular Surgical Approach for Giant Calcified Thoracic Disc Herniation: A Case Report

Calcified thoracic disc herniations (CTDH) are a rare spinal pathology that can cause progressive myelopathy and presents formidable surgical challenges due to their adherence to surrounding tissues. Herein, we describe the staged surgical management of a 41-year-old woman with symptomatic CTDH at the T8–9 level. Due to the presence of a large central calcified disc herniation, a posterior transdural approach was preferred for the initial surgery to reduce spinal cord retraction and provide direct visualization. However, extensive calcification and the risk of spinal cord injury limited adequate decompression. Because the patient’s symptoms persisted and residual compression was observed on imaging, a second surgery was performed via a posterolateral transpedicular approach. This approach provided a safe extradural corridor and allowed complete resection of the herniated disc under direct visualization, resulting in effective decompression. In cases of calcified midline giant thoracic disc herniation, staged or combined approaches may offer a safer and more effective alternative to aggressive anterior approaches.

thoracic disc herniation transdural transpedicular