PMC10070332_01
2014 preoperative magnetic resonance imaging, median sagittal T2-weighted sequence (a) and T8-T9 axial T2 weighted sequence (b), and preoperative computed tomography scan, median sagittal (c), and T8-T9 axial (d) planes, demonstrating a left paramedian T8-T9 calcific disc herniation. There was dural compression, right dislocation of the spinal cord, and an hyperintense signal, standing for myelopathy.
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F1
The MR (i.e., hyperintense on the T2-weighted images) and CT studies showed a left paramedian T8-T9 calcific disc herniation compressing the spinal cord [Figure 1].
2014 postoperative computed tomography scan (a) median sagittal, (b) T8-T9 axial, and (c) left paramedian sagittal planes. It was appreciable the residual shell of the calcified disc herniation (white rings in a and b) and the surgical wedge (white arrow in c) created by partial corpectomy of the T8-T9 vertebral bodies.
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F2
Nevertheless, the postoperative CT scan documented a residual calcified disc herniation [Figures 2 and 3].
(a) 2015 Thoracic column magnetic resonance imaging (MRI) in median sagittal T2-weighted sequence, (b) T8-T9 axial T2-weighted sequence, (c) 2017 Thoracic column MRI in median sagittal T2-weighted sequence, and (d) T8-T9 axial T2-weighted sequence. Follow-up MRI scans demonstrated the stability of the residual calcific disc herniation in time.
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F3
Nevertheless, the postoperative CT scan documented a residual calcified disc herniation [Figures 2 and 3].
(a) 2014 postoperative computed tomography (CT) scan in T8-T9 axial plane and (b) 2022 CT scan in T8-T9 plane. The comparison between the 2014 postoperative CT scan and the 2022 control CT scan at the same level confirmed the presence of the residual calcific disc at the T8-T9 level, with a new calcified herniated fragment on the left (white arrow in b).
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Eight years later, she presented with a myelopathy attributed to a CT-documented new calcified disc fragment at T8-T9 superimposed on the previously noted residual left calcific disc at the same level [Figure 4].
(a) Intraoperative T8-T9 axial computed tomography (CT) scan with navigation probe, (b) intraoperative left paramedian sagittal CT scan with navigation probe (green line), and (c) intraoperative T8-T9 axial CT scan showing the known small median calcific residual tightly attached to the dura (white arrow) and the complete removal of the recurrent herniated disc (white dotted arrow).
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T9 hemilaminectomy, and more extended removal of the T9 superior endplate. The recurrent left lateral calcific herniation was removed with a combination of Kerrison punches, the ultrasonic bone curette (Misonix), and high-speed drill. Total discal resection was confirmed on the intraoperative CT [Figure 5].
(a) Thoracic column magnetic resonance imaging (MRI), midline sagittal T2-weighted sequence and (b) thoracic column MRI, T8-T9 axial T2-weighted sequence. One-month postoperative MRI scan evidenced the presence of the median residual, a left paramedian liquor collection, and the removal of the recurrent thoracic disc herniation.
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As the leak was clearly persistent on the MR obtained 1 month later, we now recognize that the "postoperative" leak should have been operatively addressed [Figure 6].