Transforaminal Endoscopic Ventral Stenosis Decompression in Calcified Lumbar Disc Herniation: A Long Term Outcome in 79 Patients.

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Abstract

[Indexed for MEDLINE] 10. Spine (Phila Pa 1976). 2024 Mar 1;49(5):341-348. doi: 10.1097/BRS.0000000000004701. Epub 2023 May 1. Reliability of a Novel Classification System for Thoracic Disc Herniations. Farber SH(1), Walker CT(1), Zhou JJ(1), Godzik J(1), Gandhi SV(1), de Andrada Pereira B(1), Koffie RM(1), Xu DS(2), Sciubba DM(3), Shin JH(4), Steinmetz MP(5), Wang MY(6), Shaffrey CI(7), Kanter AS(8), Yen CP(9), Chou D(10), Blaskiewicz DJ(11), Phillips FM(12), Park P(13), Mummaneni PV(10), Fessler RD(12), Härtl R(14), Glassman SD(15), Koski T(16), Deviren V(10), Taylor WR(11), Kakarla UK(1), Turner JD(1), Uribe JS(1). Author information: (1)Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ. (2)Department of Neurosurgery, Baylor University, Houston, TX. (3)Department of Neurosurgery, Zucker School of Medicine at Hofstra University, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY. (4)Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Brigham and Women's Hospital, Boston, MA. (5)Department of Neurosurgery, Cleveland Clinic, Cleveland, OH. (6)Department of Neurosurgery, University of Miami, Miami Hospital, Miami, FL. (7)Department of Neurosurgery, Duke University, Durham, NC. (8)Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. (9)Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA. (10)Department of Neurosurgery, University of California San Francisco, San Francisco, CA. (11)Department of Neurosurgery, University of California San Diego, San Diego, CA. (12)Department of Neurological Surgery, Rush University, Chicago, IL. (13)Department of Neurosurgery, University of Michigan, Ann Arbor, MI. (14)Department of Neurosurgery, Weill Cornell Medicine, New York, NY. (15)Norton Leatherman Spine Center, Louisville, KY. (16)Department of Neurological Surgery, Northwestern University, Chicago, IL. STUDY DESIGN: This is a cross-sectional survey. OBJECTIVE: The aim was to assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs). SUMMARY OF BACKGROUND DATA: TDHs are complex entities varying substantially in many factors, including size, location, and calcification. To date, no comprehensive system exists to categorize these lesions. METHODS: Our proposed system classifies 5 types of TDHs using anatomic and clinical characteristics, with subtypes for calcification. Type 0 herniations are small (≤40% of spinal canal) TDHs without significant spinal cord or nerve root effacement; type 1 are small and paracentral; type 2 are small and central; type 3 are giant (>40% of spinal canal) and paracentral; and type 4 are giant and central. Patients with types 1 to 4 TDHs have correlative clinical and radiographic evidence of spinal cord compression. Twenty-one US spine surgeons with substantial TDH experience rated 10 illustrative cases to determine the system's reliability. Interobserver and intraobserver reliability were determined using the Fleiss kappa coefficient. Surgeons were also surveyed to obtain consensus on surgical approaches for the various TDH types. RESULTS: High agreement was found for the classification system, with 80% (range 62% to 95%) overall agreement and high interrater and intrarater reliability (kappa 0.604 [moderate to substantial agreement] and kappa 0.630 [substantial agreement], respectively). All surgeons reported nonoperative management of type 0 TDHs. For type 1 TDHs, most respondents (71%) preferred posterior approaches. For type 2 TDHs, responses were roughly equivalent for anterolateral and posterior options. For types 3 and 4 TDHs, most respondents (72% and 68%, respectively) preferred anterolateral approaches. CONCLUSIONS: This novel classification system can be used to reliably categorize TDHs, standardize description, and potentially guide the selection of surgical approach. Validation of this system with regard to treatment and clinical outcomes represents a line of future study. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BRS.0000000000004701