Differences in clinical and radiological features of thoracic disc herniation presenting with acute progressive myelopathy

Nakajima, Hideaki; Watanabe, Shuji; Honjoh, Kazuya; Kubota, Arisa; Matsumine, Akihiko

doi:10.1007/s00586-020-06485-6

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Nakajima et al described six cases of TDH presenting with acute (<72 h) paraplegia with Frankel grade C or worse. 4 ) Radiological findings included high thoracic lesions (T1/4) without calcification or ossification. The affected thoracic level matched the upper line of the sternum.…”

Section: Discussionmentioning

confidence: 99%

“…Symptomatic TDH is rare, accounting for 0.15% to 4% of disk herniation in surgical cases. 1,4) Awwad et al compared asymptomatic and symptomatic TDH and did not identify imaging features to classify a disk as asymptomatic or symptomatic TDH. 1) More than 80% of patients with TDH commonly present with slowly progressive myelopathy with truncal and leg pain; [2][3][4] however, acute myelopathic cases of TDH have rarely been reported.…”

Section: Clinical Characteristics and Diagnosis Of Tdhmentioning

confidence: 99%

“…1) Slowly progressive myelopathy with truncal and leg pain is a well-known TDH presentation. [2][3][4] Acute myelopathy is rarer in symptomatic cases, in which the spinal cord is severely compressed by large lesions with spinal stenosis. 4,5) We herein present three patients with TDH that encountered diagnostic challenges because they presented with acute paraparesis despite having small TDH without spinal stenosis.…”

Section: Introductionmentioning

confidence: 99%

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Small Thoracic Disk Herniation without Spinal Stenosis Presenting with Acute Myelopathy: Three Case Reports

NAKAMURA,

TAKAI

2023

NMC Case Report Journal

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We herein describe three patients with thoracic disk herniation (TDH) that presented with acute myelopathy at the Tokyo Metropolitan Neurological Hospital between 2014 and 2021 (age range, 45-76 years; male/female ratio = 1:2), with a focus on the mechanisms underlying their development. All patients had sudden-onset gait disturbance due to acute nontraumatic paraparesis. The specialties of the doctors at the first hospital were neurology and orthopedic surgery. TDH was overlooked at the first hospital, and the patients were referred to our hospital. The TDH in all cases was of the central type; however, since they were small, no spinal stenosis was observed. The key feature of all three cases is the small anterior deformation of the spinal cord, making a vascular etiology for the symptoms more plausible than a compressive etiology. After a follow-up of several months or years, two out of three patients underwent surgery with the use of the transfacet pedicle-sparing approach due to residual symptoms. Intraoperative ultrasonography showed that the spinal cord was anchored to TDH by the dural attachment of dentate ligaments. The physical relationship between the dentate ligaments and TDH may be associated with the vascular cause of the symptoms of small TDH.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Characteristics and Diagnosis Of Tdhmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Small Thoracic Disk Herniation without Spinal Stenosis Presenting with Acute Myelopathy: Three Case Reports

NAKAMURA,

TAKAI

2023

NMC Case Report Journal

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“…Как показали наши наблюдения, степень выраженности анатомической компрессии спинного мозга не коррелирует с тяжестью сенсомоторного дефицита в ногах и нарушениями функции мочевого пузыря до операции. Это наблюдение согласуется с ранее опубликованной работой Nakajima et al [5]. В ней авторы проанализировали данные по 28 пациентам с патологическим МРТ-сигналом миелопатии и компрессией спинного мозга при ГДГО и не нашли связи ни с выраженностью предоперационных симптомов, ни с исходом после операции.…”

Section: хирургическая техника торакоскопической микродискэктомииunclassified

“…Чаще всего они интерпретируются как бессимптомные. Типичной локализацией ГДГО является нижнегрудной отдел (между Th 8 и Th 12 ), что, скорее всего, связано с большей анатомической подвижностью данного сегмента и ослаблением задней продольной связки в каудальном направлении [5][6][7]. Типичной клинической манифестацией для ГДГО является локальная боль в спине или опоясывающая боль по боковой поверхности грудной клетки.…”

unclassified

Thoracoscopic microdiscectomy for disc herniation in the thoracic spine: surgical technique and analysis of early results

Kivelev,

Gaitan,

Krivoshapkin

2023

Hir. pozvonoč.

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Objective. To describe the technique and analysis of early results of thoracoscopic microdiscectomy for disc herniation in the thoracic spine.Material and Methods. A retrospective single-center study included 19 patients (15 women and 4 men) who underwent thoracoscopic microdiscectomy in 2018–2020. The median age of patients was 45 years (range 21–75 years); the median time from the onset of symptoms to the first visit to a neurosurgeon was 12 months (range 1–152 months). Before admission to the hospital, all patients complained of pain of varying intensity in the thoracic spine and/or along the lateral surface of the chest. Nine (47 %) patients had sensorimotor neurological deficit in the legs. The outcomes of operations were assessed using the modified MacNub scale, and postoperative complications were classified according to the Clavien – Dindo scale. Early results of treatment were evaluated at the first follow-up examination (on average, 2 months after the intervention). Data analysis was performed using the SPSS statistical program (IBM SPSS Statistics, version 27).Results. The immediate postoperative period was mostly uneventful in 15 (79 %) patients. Four (21 %) Clavien – Dindo grade 1 complications were registered: 1 (5 %) case of purulent discitis, 1 (5 %) pneumonia, 1 (5 %) worsening of sensory disturbances in the leg, and 1 (5 %) deep vein thrombosis of the leg. The average length of hospital stay was three days. Favorable results (excellent, improvement or satisfactory) according to the modified MacNub scale were registered in 16 (84 %) patients in two months after surgery. In three (16 %) cases, the symptoms remained unchanged (unsatisfactory according to the MacNub scale). No deterioration was recorded in any of the cases. Statistical analysis of the data (Fischer’s method, Mann – Whitney U-test) showed that the only prognostic factor affecting the outcome of the operation was the localization of the hernia in the lower thoracic region between the T8 and T12 vertebrae (p = 0.007). Thus, all nine patients with a hernia in the midthoracic region (T4–T8) had a favorable outcome of the operation, in 6 (67 %) of them there were no complaints. In three (30 %) out of 10 patients with a hernia in the lower thoracic region, there was no complete cure. All other factors (gender, age, hernia size, etc.) did not have a statistically significant correlation with the outcome.Conclusion. Thoracoscopic microdiscectomy can be used in the surgical treatment of herniations of the thoracic spine. Additional studies are needed to confirm the effectiveness and safety of the technique in the long term.

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Diagnostik und Therapie des Bandscheibenvorfalls

Benditz¹,

Koehl²,

Necula³

et al. 2023

Schmerzmed.

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Differences in clinical and radiological features of thoracic disc herniation presenting with acute progressive myelopathy

Cited by 5 publications

References 16 publications

Small Thoracic Disk Herniation without Spinal Stenosis Presenting with Acute Myelopathy: Three Case Reports

Small Thoracic Disk Herniation without Spinal Stenosis Presenting with Acute Myelopathy: Three Case Reports

Thoracoscopic microdiscectomy for disc herniation in the thoracic spine: surgical technique and analysis of early results

Diagnostik und Therapie des Bandscheibenvorfalls

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