Abstract Purpose Though rare, thoracic disc herniation (TDH) can lead to debilitating myelopathy and poses considerable surgical challenges. The consistency of the herniated disc—soft versus calcified—may significantly influence surgical planning and perioperative outcomes. This retrospective study compares clinical features, surgical parameters, and neurological outcomes in patients with calcified versus soft TDH. Methods Thirty-six patients with thoracic myelopathy due to TDH were treated at a tertiary spine centre between 2018 and 2024. Patients were stratified into calcified (n = 20) and soft (n = 16) disc cohorts based on imaging and intraoperative findings. Data included demographics, imaging, operative details, and neurological outcomes. A P-value 0.05 was considered significant. Results Baseline demographics were comparable. Calcified cases had higher blood loss (450 mL versus 275 mL, P = 0.027), more IONM alerts (33% versus 0%, P = 0.02), and a trend toward more postoperative deficits. Long-term neurological outcomes were comparable (35% versus 31% improved, P = 0.40). Conclusions Calcified TDHs are associated with greater surgical complexity and risk. However, with appropriate planning, long-term outcomes match those of soft discs. Disc morphology should inform intraoperative strategy but does not necessarily predict prognosis.
Egu et al. (Sun,) studied this question.