Thoracic disc herniation case reports [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Thoracic disc herniation case reports ======

===== 2022 =====

A 65-year-old female patient underwent a [[transthoracic]] [[endoscopic approach]] to remove a [[calcified thoracic disc herniation]] that caused [[spinal cord compression]]. Despite having a long learning curve, the [[surgical technique]] described herein can be even used in patients with complex and calcified thoracic disc herniations. The [[video]] can be found here
https://stream.cadmore.media/r10.3171/2022.3.FOCVID221
((Fernández RC, Mesa M, Rosenthal D, Rodrigo Paradells V. Antero-lateral transthoracic endoscopic approach for a calcified thoracic disc herniation. Neurosurg Focus Video. 2022 Jul 1;7(1):V3. doi: 10.3171/2022.3.FOCVID221. PMID: 36284728; PMCID: PMC9558909.))
===== 2018 =====
A 57 year- old man with lateral [[abdominal wall bulging]]. MRI showed [[thoracic disc herniation]] at the T11-T12 level. Needle electomyogram disclosed acute denervation in paraspinal and abdominal muscles innervated from T11 root. Eight months later the swelling was reduced significantly. Thoracic disc herniations are rare and three similar cases have been described previously
((Zambelis T, Polydorou A, Anagnostou E, Angourakis P, Vassilopoulou S. Unusual 
presentation of thoracic disc herniation. Br J Neurosurg. 2018 Apr 24:1-2. doi:
10.1080/02688697.2018.1466996. [Epub ahead of print] PubMed PMID: 29688067.
)).
----
A 50-year-old woman with progressive [[myelopathy]] who was diagnosed with a [[thoracic spinal cord herniation]]. Microsurgical exploration revealed an anterior vertical dural defect and a small concomitant [[disc herniation]], occult on the preoperative imaging, which caused the dural defect and led to [[idiopathic spinal cord herniation]] (ISCH). This intraoperative finding corroborates the emerging notion that disc herniation is the underlying cause of ISCH
((Ulrich CT, Fung C, Piechowiak E, Gralla J, Raabe A, Beck J. Disc herniation,
occult on preoperative imaging but visualized microsurgically, as the cause of
idiopathic thoracic spinal cord herniation. Acta Neurochir (Wien). 2018
Mar;160(3):467-470. doi: 10.1007/s00701-018-3466-3. Epub 2018 Jan 19. PubMed
PMID: 29350292.
)).
----

A 69-year-old male referred to [[physical therapy]] for the treatment of LBP after having seen two medical doctors. He presented with severe spinal pain with [[gait disorder]], [[postural balance]] deficits and bilateral loss of plantar flexor strength. Decreased sensation in the [[buttock]]s and a subtle episode of [[urinary incontinence]] were also present.

Based on the results of the history and physical examination, the patient was referred back to his medical practitioner, who ordered magnetic resonance imaging. A thoracic disc herniation associated with spondyloarthritis at T10-11 causing myelopathy was detected, and the patient underwent immediate decompressive surgery. One month following initial evaluation, the patient had completely recovered without any neurological compromise.

This case highlights the importance of the screening of serious pathologies and the assessment of central nervous impairments in certain cases of LBP. The integration of a cluster of subjective and physical examination findings led to the prompt referral of this patient for urgent medical attention
((Christe G, Hall T. The screening process of a patient with low back pain and
suspected thoracic myelopathy: a case report. J Man Manip Ther. 2018
Feb;26(1):11-17. doi: 10.1080/10669817.2017.1282189. Epub 2017 Jan 23. PubMed
PMID: 29456443; PubMed Central PMCID: PMC5810765.
)).
===== 2017 =====
A 45 years old male case with complaint of [[neck pain]] radiating to right upper extremity. The physical examination revealed Th1 radiculopathy symptoms. According to his images degeneration at C6-7 level and right T1 root compression due to Th1-Th2 disc herniation at foraminal region were evaluated. The patient underwent [[hemilaminectomy]], f[[oraminatomy]] and [[discectomy]] at T1-T2 level via posterior approach.

T1-2 level thoracic disc herniation can accompany with cervical region problems and some syndromes can mimic Th1 radiculopathy symptoms. The aim of this case report is to keep on mind of this rare condition and to emphasize the importance of physical findings and correlations with magnetic resonance imaging
((Gokcen HB, Erdogan S, Gumussuyu G, Ozturk S, Ozturk C. A Rare Case of T1-2
Thoracic Disc Herniation Mimicking Cervical Radiculopathy. Int J Spine Surg. 2017
Nov 28;11:30. doi: 10.14444/4030. eCollection 2017. PubMed PMID: 29372134; PubMed
Central PMCID: PMC5779266.
)).
----


A young patient who presented with Horner's Syndrome caused by a T1-T2 [[thoracic disc herniation]] 
The 34-year-old female patient was admitted to the emergency department presenting a sudden onset history of ptosis and miosis on the left eye (Horner's Syndrome). She reported a 2-month history of neck, scapular and medial left arm and forearm pain and numbness. The cervical MRI showed a T1-T2 left disc herniation with intraforaminal compression of T1 nerve root. A microdiscectomy was performed and both left arm pain and Horner's Syndrome have completely regressed.

Symptomatic T1-T2 disc herniation is an uncommon condition in a spine surgeon daily routine. The differential diagnosis for patients presenting upper limb pain and Horner's Syndrome should include upper thoracic disc herniation. Patients' outcomes can be excellent if an adequate surgical treatment is timely provided
((Teixeira JC, Santos MM, Melancia JL. T1-T2 herniated disc presenting with
Horner's syndrome. World Neurosurg. 2017 Aug 22. pii: S1878-8750(17)31370-0. doi:
10.1016/j.wneu.2017.08.069. [Epub ahead of print] PubMed PMID: 28842234.
)).