Top

European Spine Journal

Published in:

01-07-2020 | Disc Herniation | Original Article

Spontaneous regression of calcified thoracic herniations: Can Hounsfield-units radiodensity have a predictive value?

Authors: F. Cofano, P. Berjano, G. Vercelli, G. Palmieri, M. Pejrona, F. Zenga, D. Garbossa

Published in: European Spine Journal | Issue 7/2020

Abstract

Introduction

Spontaneous regressions of calcified thoracic disc herniations (TDH) have been rarely described. Since now, no previous papers hypothesized that radiological factors could be able to predict the evolution of the herniation. This study shows that the radiodensity of the herniated material in herniations with spontaneous resolution might differ from that of operated herniations.

Methods

This is a retrospective study. A cohort of patients that underwent surgical removal of a calcified thoracic disc herniation has been compared to two cases conservatively treated and a case with spontaneous regression. CT scans were evaluated to compute the average radiodensity [in Hounsfield units (HU)] of the calcified components of the herniations. All the slices of the CT scans involving the calcification were evaluated in their axial images and in their coronal and sagittal reformations. Comparison of the slices radiodensity (spontaneously resolved versus surgically treated) was performed with the unpaired Student’s t test.

Results

The mean density of calcification in the case with spontaneous regression was found to be 454 HU. In the control group of surgical cases observed, and the conservatively treated cases, the mean HU density showed higher values (respectively, 827 and 853 HU) (p < 0.01).

Conclusion

Qualitative differences between calcified TDH that resolve spontaneously or need surgical treatment might be shown by differences of radiodensity. This comparative study, in spite of the limitations due to small numbers, provides a new insight in the interpretation of the phenomenon of spontaneous resolution of calcified TDH.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Available only for authorised users

Zhong M, Liu JT, Jiang H, Mo W, Yu PF, Li XC et al (2017) Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Pain Physician. 20(1):E45–E52PubMed

Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY (2015) The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil 29(2):184–195PubMedCrossRef

Kobayashi N, Asamoto S, Doi H, Ikeda Y, Matusmoto K (2003) Spontaneous regression of herniated cervical disc. Spine J 3(2):171–173PubMedCrossRef

Gurkanlar D, Yucel E, Er U, Keskil S (2006) Spontaneous regression of cervical disc herniations. Minim Invasive Neurosurg 49(3):179–183PubMedCrossRef

Orief T, Orz Y, Attia W, Almusrea K (2012) Spontaneous resorption of sequestrated intervertebral disc herniation. World Neurosurg 77(1):146–152PubMedCrossRef

Kobayashi N, Asamoto S, Doi H, Ikeda Y, Matusmoto K (2003) Spontaneous regression of herniated cervical disc. Spine J 3(2):171–173PubMedCrossRef

Mochida K, Komori H, Okawa A, Muneta T, Haro H, Shinomiya K (1998) Regression of cervical disc herniation observed on magnetic resonance images. Spine 23(9):990–995PubMedCrossRef

Piccirilli M, Lapadula G, Caporlingua F, Martini S, Santoro A (2012) Spontaneous regression of a thoracic calcified disc herniation in a young female: a case report and literature review. Clin Neurol Neurosurg 114(6):779–781PubMedCrossRef

Ahmad FU, Schallert E, Bregy A, Post JD, Vanni S (2016) Disappearing large calcified thoracic disc herniation in a patient with thalassaemia. BMJ Case Rep 28:2016

10.

Brauge D, Madkouri R, Clément R, Reina V, Brauge T, Gaillard S (2017) What are the possibilities of spontaneous resorption of a thoracic disc herniation occupying more than 20% of the spinal canal in the asymptomatic subject? Comparative study. J Clin Neurosci 44:269–273PubMedCrossRef

11.

Sari H, Misirlioglu TO, Palamar D (2016) Regression of a symptomatic thoracic disc herniation with a calcified intervertebral disc component. Acta Orthop Traumatol Turc 50(6):698–701PubMedPubMedCentralCrossRef

12.

Wood K, Blair J, Aepple D, Schendel M, Garvey T, Gundry C et al (1997) Natural history of asymptomatic thoracic disk herniation. Spine 22(5):525–529PubMedCrossRef

13.

Okada Y, Shimizu K, Ido K, Kotani S (1997) Multiple thoracic disc herniations: case report and review of the literature. Spinal Cord 35:183–186PubMedCrossRef

14.

Berjano P, Garbossa D, Damilano M, Pejrona M, Bassani R, Doria C (2014) Transthoracic lateral retropleural minimally invasive microdiscectomy for T9-T10 disc herniation. Eur Spine J 23(6):1376–1378PubMedCrossRef

15.

Berjano P, Gautschi OP, Schils F, Tessitore E (2015) Extreme lateral interbody fusion (XLIF^®): how I do it. Acta Neurochir (Wien) 157(3):547–551CrossRef

16.

Martinez-Quinones JV, Aso-Escario J, Consolini F, Arregui-Calvo R (2010) Regresiòn espontànea de hernias discales intervertebrales. A propòsito de una serie de 37 casos. Neurocirurgìa 21:108–117CrossRef

17.

Ayhan S, Nelson C, Gok B et al (2010) Transthoracic surgical treatment for centrally located thoracic disc herniations presenting with myelopathy: a 5-year institutional experience. J Spinal Disord Tech 23(2):79–88PubMedCrossRef

18.

Quint U, Bordon G, Preissl I, Sanner C, Rosenthal D (2012) Thoracoscopic treatment for single level symptomatic thoracic disc herniation: a prospective followed cohort study in a group of 167 consecutive cases. Eur Spine J 21(4):637–645PubMedCrossRef

19.

Andrade P, Cornips EMJ, Sommer C, Daemen MA, Visser-Vandewalle V, Hoogland G. Elevated inflammatory cytokine expression in CSF f. Spine J. 2018. pii: S1529-9430(18)31082-9

20.

Coumans J-VCE, Neal JB, Grottkau BE, Nahed BV, Shin JH, Walcott BP (2016) Giant thoracic osteophyte: a distinct clinical entity. J Clin Neurosci 21(9):1599–1602CrossRef

21.

Gille O, Soderlund C, Razafimahandri HJC, Mangione P, Vital J-M (2006) Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy. Eur Spine J 15(5):537–542PubMedPubMedCentralCrossRef

22.

Lipson SJ, O’Connell JX (1991) Case 37-1991: a 47-year-old woman with back pain and a lesion n a vertebral body. N Engl J Med 325(11):794–799CrossRef

23.

Srinivasan V, Kesler H, Johnson M, Dorfman H, Walter K (2012) Tophaceous pseudogout of the thoracic spine. Acta Neurochir 154(4):747–750PubMedCrossRef

24.

Patel SP, Lee JJ, Hecht GG, Holcombe SA, Wang SC, Goulet JA (2016) Normative vertebral hounsfield unit values and correlation with bone mineral density. J Clin Exp Orthop 2:14CrossRef

Title: Spontaneous regression of calcified thoracic herniations: Can Hounsfield-units radiodensity have a predictive value?
Authors: F. Cofano
P. Berjano
G. Vercelli
G. Palmieri
M. Pejrona
F. Zenga
D. Garbossa
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keyword: Disc Herniation
Published in: European Spine Journal / Issue 7/2020
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-06192-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Spontaneous regression of calcified thoracic herniations: Can Hounsfield-units radiodensity have a predictive value?

Abstract

Introduction

Methods

Results

Conclusion

Graphic abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Graphic abstract

Please log in to get access to this content

Other articles of this Issue 7/2020

Computed tomography imaging characteristics help to differentiate pyogenic spondylitis from brucellar spondylitis

Subsidence after total lumbar disc replacement is predictable and related to clinical outcome

Is Cutibacterium acnes early surgical site infection rate related to the duration of antibiotic prophylaxis in adolescent idiopathic scoliosis surgery?

Announcements

Answer to the Letter to the Editor of Tamburrelli FC et al., concerning “Prone single-position extreme lateral interbody fusion (Pro-XLIF): preliminary results” by Lamartina C and Berjano P (Eur Spine J; 2020: https://doi.org/10.1007/s00586-020-06303-z)

Long-term clinical outcome of two revision strategies for failed total disc replacements