Thoracic Disk Herniation Resulting in Acutely Progressing Paraplegia in a Pediatric Patient

Giblin, Erica; Hochheiser, Gary M.

doi:10.1097/pec.0b013e318180ff1d

Cited by 7 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the pediatric population, there are merely case reports of symptomatic TDHs [6] [16]- [18], including one 16-year-old girl with a T10-T11 disc herniation at the upper limit of the TLJ [8]. These TDHs (especially when calcified and/or associated with Scheuermann's disease) may be related to a growth disturbance rather than to disc degeneration [12] [23].…”

Section: Incidence and Clinical Presentation Of Tljdhsmentioning

confidence: 99%

Thoraco-Lumbar Junction Disc Herniation and Tight Filum: A Unique Combination?

Cornips¹,

Beuls²,

Weber³

et al. 2014

IJCM

View full text Add to dashboard Cite

Purpose: The incidence of both symptomatic thoraco-lumbar junction disc herniation (TLJDH) and tight filum (TF) may be underestimated. Both conditions have a complex clinical presentation that may involve the distal spinal cord, conus medullaris, and/or cauda equina, including upper and/or lower motor neuron impairment, sensory impairment, urological and sexual dysfunction. The coexistence of both conditions has not been previously reported and may be a diagnostic and therapeutic challenge. Methods: We report three teenage girls, a 24-year-old woman, and two middleaged women who were diagnosed with both conditions and treated at our institution. Results: Disc herniation level was T11-T12 in 2, T12-L1 in 3, and L1-L2 in one. All patients had a fatty filum (n = 5) and/or a low-lying CM (at or above L1-L2 in 2, at or below L2-L3 in 4), and were treated with filum sectioning first. All patients noted marked improvement of preoperative complaints including back pain (n = 5), leg pain and fatigue (n = 4), urological complaints (n = 4), and toe gait (n = 1). One 16-year-old girl successfully underwent a thoracoscopic microdiscectomy for persisting pain at the thoraco-lumbar junction two years after filum sectioning. Conclusions: Thoraco-lumbar junction disc herniation and tight filum both act on the distal spinal cord close to the transition to the cauda equina. Both conditions may coincide and may even act synergistically, the disc herniation acting as a fulcrum, aggravating the deleterious effect of the tethering force (and vice versa). This might explain why both conditions combined may present at a younger age. We suggest filum sectioning as the primary treatment option in all patients, however, more cases and a longer follow-up are needed to better understand their unique combination and interaction. Nevertheless, when confronted with a symptomatic TLJDH especially in young patients we advise to rule out a coinciding TF by careful consideration of all clinical, radiological, and urological data.

show abstract

Section: Incidence and Clinical Presentation Of Tljdhsmentioning

confidence: 99%

Thoraco-Lumbar Junction Disc Herniation and Tight Filum: A Unique Combination?

Cornips¹,

Beuls²,

Weber³

et al. 2014

IJCM

View full text Add to dashboard Cite

show abstract

“…We can also suggest that thoracic intervertebral disc herniation may remain a missed diagnosis, if it is not considered within the range of preliminary diagnoses in cases with dorsalgia. [16][17][18][19][20] In conclusion, several conclusions may be made regarding the MRI findings in patients with dorsalgia. Magnetic resonance imaging is a precise imaging technique for investigating patients with complaint of dorsalgia.…”

Section: Discussionmentioning

confidence: 95%

“…Our results and also Linscott and Heyborne, [2] results were higher than those mentioned in previous studies. [4,[14][15][16] Degenerative disc disease was present in 22% (525/2,340) of the levels, whereas loss of disc height was determined in 17% (387/2,340). The findings related to the incidences and locations of the degeneration and the loss of disc height were in accordance in our study sample, both being more frequent at lower thoracic intervertebral disc levels.…”

Section: Discussionmentioning

confidence: 99%

The incidence and most common levels of thoracic degenerative disc pathologies

Sarsilmaz

Yencilek

Özelçi

et al. 2018

Turk J Phys Med Rehab

View full text Add to dashboard Cite

Objectives: In this study, we aimed to describe and characterize the incidence of thoracic degenerative disc pathologies, bulging/herniation, and the most common affected levels. Patients and methods: Between January 2008 and May 2012, a total of 195 patients (109 females, 86 males; mean age 43.5 years; range, 15 to 74 years) who were admitted with the complaint of dorsalgia and underwent magnetic resonance imaging (MRI) of the thoracic vertebral column were included in the study. Data including MRI findings, endplate and disc degeneration, disc height loss, bulging, and disc herniation were retrospectively analyzed. Results: Of 3,348 patients, 195 patients had disc bulging/herniation. When 12 levels in 195 cases were taken into consideration, disc pathologies were found in 412 (18%) levels among the total of 2,340 intervertebral disc levels. Bulging was present in 11% (244/2,340) of the levels. Disc herniation was present in 7% (168/2,340) of the levels. The most commonly affected site was T 7-8 , followed by T 8-9 and T 11-12. Conclusion: Thoracic disc pathologies are still a significant diagnostic challenge. Our study results show that the incidence of these pathologies is higher than expected.

show abstract

“…This radicular pain is because of lumbosacral root compression by lower thoracic disk herniation after they exit from the enlargement of spinal cord before conus. The intradural roots in this place follow a highly organized arrangement with the rostral roots laterally and caudal ones centrally ( 7 ). Thus, a central disk herniation in lower thoracic area is sufficient to cause sciatica-like pain.…”

Section: Discussionmentioning

confidence: 99%

Lower thoracic disc herniation mimicking lower lumbar disk disease: A case report

Golbakhsh

Mottaghi

Zarei

2017

Med. J. Islam. Republic Iran

View full text Add to dashboard Cite

Thoracic disk herniation comprises 0.15% of all disk herniation and has various and confusing manifestations. Among them, radicular pain down the leg could be the rarest presentation, especially if it is the only complaint. On the other hand, finding the relationship between clinical and paraclinical needs require high index of suspension and it is demanding. A 34-year-old patient, who had a history of intermittent back pain, with lower thoracic disk herniation presented by acute leg sciatica-like pain, is reported. He suffered 3 weeks of acute back pain prior to admission, which radiated down to buttock and leg, with a vague left abdominal pain, whose clinical examination indicated a distal lumbar problem. MRI showed T-12 L-1 disk herniation. Lower thoracic disc herniation can compress lumbosacral roots immediately after exiting from cord thickening in the lower thoracic area, so they can incite lower lumbar radiculopathy and cause discordance between MRI findings and clinical presentation, suggesting a lumbar problem, and this can lead to delayed diagnosis. However, the acute pain was completely improved after open discectomy.

show abstract

Thoracic Disk Herniation Resulting in Acutely Progressing Paraplegia in a Pediatric Patient

Cited by 7 publications

References 12 publications

Thoraco-Lumbar Junction Disc Herniation and Tight Filum: A Unique Combination?

Thoraco-Lumbar Junction Disc Herniation and Tight Filum: A Unique Combination?

The incidence and most common levels of thoracic degenerative disc pathologies

Lower thoracic disc herniation mimicking lower lumbar disk disease: A case report

Contact Info

Product

Resources

About