Thoracic Disk Herniation With Paraparesis Treated With Transthoracic Microdiskectomy in a 14-year-old Girl

Abstract

Herniated thoracic intervertebral disk causing spinal cord compression with paraparesis is uncommon in adults and rare in children. This article describes a case of pediatric thoracic disk herniation with paraparesis treated surgically.A 14-year-old girl presented with a 4-month history of diffuse back pain and sudden onset paraparesis. Motor strength was 4/5 in both legs, and she had lost the ability to ambulate. Magnetic resonance imaging revealed spinal cord compression due to a herniated intervertebral disk at T5-T6. Computed tomography scan after myelogram demonstrated anterior dural sac compression at T5-T6 but no intervertebral disk calcification. She underwent transthoracic microdiskectomy. The herniated disk was removed, and the thoracic spinal cord was decompressed. No fusion was performed after microdiskectomy. The postoperative course was uncomplicated, and neurologic deficit resolved within 2 weeks postoperatively. The patient was pain free with no neurologic deficit at 24-month follow-up, and computed tomography scan showed remodeling of the T5 and T6 vertebral bodies.Most cases of thoracic disk herniation are asymptomatic. If no compression of the spinal cord exists, the natural history of the disease justifies conservative management. Although the treatment of choice is conservative, surgery is required in patients who develop progressive neurologic deficit or severe radicular pain. Transthoracic microdiskectomy without fusion is considered a treatment in similar cases.

Is There a Place for the Posterior Approach in Cases of Acute Myelopathy on Thoracic Disc Hernia?

“…This is not the case for other authors who have reported similar cases. [11][12][13][14][15][16][17][18] Apart from these few case reports, the only published results of surgery for acute myelopathy due to TDH is the series reported by Cornips et al, 8 who estimated the frequency of this condition at 4% of surgeries for TDH, highlighting the rarity of this situation.…”