Histologically proven acute paediatric thoracic disc herniation causing paraparesis: a case report and review of literature

Abstract

MR imaging demonstrated an unusual lateral and dorsally based lesion at T7/8 causing cord compression which was thought to represent an epidural haematoma. Urgent posterior decompressive surgery was performed but no evidence of haematoma was seen, a large well-circumscribed solid piece of soft tissue was found in the extradural space causing significant cord compression. This was sent for histological analysis and subsequently reported as showing cartilaginous disc material. Postoperative MR imaging at 2 weeks and 3 months demonstrates complete resection of this disc material with no significant kyphotic deformity on standing X-ray at 18 months. Complete neurological recovery occurred over the subsequent 3 months following emergent surgery, and at 18-month review, the patient remains asymptomatic and fully independent.

Serious diagnoses at revisits in children discharged from the emergency department with back pain

“…While back pain is frequently musculoskeletal in origin, [1][2][3] it can be a harbinger for more serious pathology including infection and malignancy. 2,4,5,6,7,8 Serious pathologies, such as intraspinal abscess and cauda equina syndrome, require timely diagnosis and intervention to prevent severe sequelae. [9][10][11] Others, such as pyelonephritis and pancreatitis, do not involve the spine or lead to neurologic sequelae but can present as back pain and require timely intervention.…”