Unexpected Combined Double Posterior and Anterior Approach to Treat Thoracic Disc Herniation: a Case Report

Abstract

Introduction: Although frequently observed in magnetic resonance images, symptomatic thoracic disc herniations are rare. Surgical treatment is indicated when patients suffer from functional symptoms with no response to medical treatment, when neurologic symptoms appear or worsen or in the event of myelopathy. Posterolateral approaches are commonly accepted as the treatment for lateral and mediolateral disc herniations and non-calcified medial herniations. On the other hand, anterior approaches have been accepted to treat gigantic calcified medial disc herniations. Case presentation: This case report presents on a 57-year-old female patient suffering from thoracolumbar pain and impairment. The magnetic resonance study showed images compatible with a posteromedial T12-L1 disc herniation that, after medical treatment failure, required surgical treatment. Initially, a posterior approach was performed, resulting in the immediate postoperative period in motor and sensitive deficit of the lower left limb, so a surgical reintervention was performed using an anterior approach, obtaining good clinical and functional results. Conclusion: Thoracic disc herniations are uncommon. Surgical indication is decided in the presence of neurologic symptoms. Neurologic injury is a common complication due to the lesion’s characteristics and it can also be secondary to the surgical procedure. An adequate election of the surgical approach may minimize neurologic injuries.