Bilateral thoracic disc herniation with abdominal wall paresis: a case report

Abstract

We present a rare case of a patient initially presenting with unilateral abdominal wall bulging and radicular pain caused by a lateral disc herniation at Th11/12, later suffering from a hernia recurrence with bilateral disc prolapse and motor deficits. The patient underwent sequesterectomy via a right hemilaminectomy at Th11, and after 8 weeks, a bilateral sequesterectomy with semirigid fusion Th11/12 was performed. Unilateral motor deficits at the thoracic level have been discussed in case reports; a bilateral disc protrusion with abdominal wall bulging occurring as a recurrent disc herniation has never been described before.

Abdominal wall pseudohernia - One secondary to a thoracic extraforaminal disc herniation and other due to thoracic paracentral disc protrusion

“…There are some published case reports of thoracic disc herniations causing abdominal wall pseudohernias or paresis. 4,10 The second case is similar to published reports. However, as far as the authors are aware, our first case is the first published case of an extraforaminal disc herniation as the cause an abdominal wall pseudohernia.…”

“…Complications of abdominal wall pseudohernias have been reported, particularly those that affect activities of daily living such as gait disturbances and disturbance of bowel function leading to constipation and paralytic ileus. 9 Thoracic disc herniations, whilst not uncommon, are rarely symptomatic 3,4 therefore the thoracic spine might not be examined as scrupulously as the lumbar region for disc pathology on imaging, especially if the request asks the radiologist to focus on an abdominal wall problem.…”

“…Thoracic disc herniations are less common and are rarely symptomatic. 3,4 They can therefore be easily overlooked as a potential cause of symptoms.…”

Curative Effect of Foraminal Endoscopic Surgery and Efficacy of the Wearable Lumbar Spine Protection Equipment in the Treatment of Lumbar Disc Herniation

“…Imaging suggests that the severity of HLD is serious; however, the pain symptoms of patients are not obvious, or there is no pain performance. Some patients have severe pain symptoms; however, the results of CT and MRI suggest that the severity of HLD is not obvious [26]. In [27], an SLR is performed to compare the efficacy of various treatment methods followed for lumbar disc herniation.…”

Spinal surgery for gallstones disease – Case report of a rare differential diagnosis

“…To exclude other neurologic conditions mimicking a nerve root compression-like thoracic diabetic neuropathy or segmental zoster eruption, needle electromyography (EMG) may also be helpful. Malignancies may be ruled out by contrast-enhanced CT scan [10] .…”