Upper thoracic disc herniation followed by acutely progressing paraplegia

Abstract

Study design: Case report. Objective: To report a rare thoracic intervertebral disc herniation followed by acutely progressing paraplegia. Setting: Spinal Injuries Center, Fukuoka, Japan. Method: A 37-year-old man presented with sudden severe backache and acutely progressing motor impairments of both lower extremities after antecedent backache lasting about 5 days. Neurological examination showed analgesia and hypoesthesia below the T4 dermatome level, dysesthesia to pinprick below right inguinal level, and severe motor impairments of the lower extremities (Frankel classification C). Magnetic resonance (MR) imaging demonstrated spinal cord compression due to a postero-laterally existing epidural mass at the T2-T3 level. After laminectomy at the T2-T3 level, the sequestrated disc material was detected and excised as one piece through the right side of the dura. The excised herniated mass had a ring-like form and was thought to originate from the annulus fibrosis. Result: After the emergency surgery, he had complete relief from the backache and control of both lower extremities recovered gradually. At 4 weeks after the emergent operation, motor power of both lower extremities recovered almost completely. He was able to walk without any assistance. MR imaging study after surgery did not reveal the sequestrated mass, except for a mild disc bulging at the T2-T3 level. Conclusion: Accurate diagnosis of acute symptomatic thoracic disc herniation is occasionally difficult. However, timely and successful surgery could result in complete symptom relief and satisfactory results.Spinal Cord (2005) 43, 741-745.

Thoracic disc herniation and acute myelopathy: clinical presentation, neuroimaging findings, surgical considerations, and outcome

“…When analyzing our personal series and case reports in the literature, 6,12,14,15,17,24,28 it seems that TDHs presenting with an acute myelopathy share some particular radiological and clinical features.…”

“…Although some authors have stated that TDHs more frequently cause an acute paraplegia than their cervical counterparts, 12,25 there are actually few case reports concerning this entity. 5,6,12,14,15,17,24,28 Interestingly, we have treated 8 patients affected by an acute myelopathy (including 3 with paraplegia, 2 with severe paraparesis, and 1 with severe monoparesis) at our institution over the past 8 years. When confronted with such a patient, the surgeon has to decide whether to perform an emergency operation and if so, whether to use an anterior or posterior approach, considering the anticipated risk of such an attempt.…”

“…Unfortunately, the literature brings little, if anything, that helps in making the right decision. 3,6,12,15,17,24 In this study, we therefore focus on clinical presentation, imaging findings, surgical timing, surgical technique, and outcome. We hope this will contribute to our understanding of this entity and improve our care for these patients.…”

Thoracic Disc Herniation of the Adjacent Segment With Acutely Progressing Myelopathy

“…However, the symptoms usually progress slowly when it does occur [9]. Sasaki et al [10] was the first to describe upper thoracic disc herniation followed by acutely progressing paraplegia, and several authors have reported that thoracic disc herniation is usually associated with radiological disc calcification [11-13]. However, in our case, the CT scans and gross examination of the excised herniated disc failed to provide any evidence of calcification.…”

“…However, in our case, the CT scans and gross examination of the excised herniated disc failed to provide any evidence of calcification. Two reports have described cases of thoracic disc herniation sequestrated to the posterior side of the spinal canal that resulted in paraplegia [10,14]. In these cases, the thoracolumbar radiographs and CT also showed no herniated disc calcification.…”