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 1)
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 2).
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 3).
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 buttocks 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 4).
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, foraminatomy 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 5).
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 6).