González-Camacho E, Chavarreti-Gutiérrez OM, Tejera-Morett A, Sánchez-García FJ, De HJ, Dittmar-Johnson HM, Cruz-López F, Lira-Hernández EA

Language: Spanish
References: 12
Page: 35-38
PDF size: 237.12 Kb.

ABSTRACT

Introduction: thoracic disc herniation (TDH) are rare lesions, representing 0.1 to 3% of all herniated discs. They appear in young adults, without predominance of sex and they have a progressive course; its diagnosis and treatment are often difficult. Case description: 27-year-old male with a two-month evolution, characterized by paresthesia and hypoesthesia in the lower limbs, dorsolumbar pain, changes in sensation on the lateral aspect of the thighs and legs, difficulty walking due to loss of strength, as well as urinary symptoms; it was initially evaluated by a neurologist who suggests a diagnosis of transverse myelitis and was treated with methylprednisolone, with partial improvement of symptoms, presenting relapse 2 weeks later. Imaging studies were performed (X-rays and CT scan without alteration), magnetic resonance imaging of the thoracic spine with the presence of a T6-T7 disc herniation. It was decided to perform surgical management by means of posterior discectomy with the use of a microscope and unilateral instrumentation of the segment. The patient presented recovery of neurological compromise at 8 weeks, achieving a gait with normal characteristics, with adequate strength and sensitivity in the pelvic limbs. Conclusions: TDH are rare, their diagnosis is usually difficult because they present with neurological deterioration and signs of myelopathy, which could simulate neurological pathologies. In the treatment of TDR, the presence of significant axial or radicular pain, as well as myelopathy are considered surgical indications, in which case the use of a microscope during the discectomy not only provides excellent vision, but could also reduce the risk of neurological injury.

REFERENCES

1. Hott JS, Feiz-Erfan I, Kenny K, Dickman CA. Surgical management of giant herniated thoracic discs: analysis of 20 cases. J Neurosurg Spine. 2005; 3: 191-197.

2. Arce CA, Dohrmann GJ. Thoracic disc herniation: Improved diagnosis with computed tomographic scanning and a review of theliterature. Surg Neurol. 1985; 23: 356-361.

3. Williams MP, Cherryman GR. Thoracic disk herniation: MR imaging. Radiology. 1988; 167 (3): 874-875.

4. Dietze DD Jr, Fessler RG. Thoracic disc herniations. Neurosurg Clin N Am. 1993; 4: 75-90.

5. Lyu R, Chang H, Tang L, et al. Thoracic disc herniation mimicking acute lumbar disc disease. Spine. 1999; 15: 416-418.

6. Kerezoudis P, Rajjoub KR, Goncalves S, et al. Anterior versus posterior approaches for thoracic disc herniation: Association with postoperative complications. Clin Neurol Neurosurg. 2018; 167: 17-23.

7. Cornips EM, Janssen ML, Beuls EA. Thoracic disc herniation and acute myelopathy: clinical presentation, neuroimaging findings, surgical considerations, and outcome. J Neurosurg Spine. 2011; 14: 520-528.

8. Morgan H, Abood C. Disc herniation at T1-2. Report of four cases and literature review. J Neurosurg. 1998; 88: 148-150.

9. Quint U, Bordon G, Preissl I, et al. Thoracoscopic treatment for single level symptomatic thoracic disc herniation: a prospective followed cohort study in a group of 167 consecutive cases. Eur Spine J. 2012; 21: 637-645.

10. Guest JD, Griesdale DE, Marotta T. Thoracic disc herniation presenting with transient anterior spinal artery syndrome. A case report. Interv Neuroradiol. 2000; 6: 327-331.

11. Oppenlander ME, Clark JC, Kalyvas J, et al. Surgical management and clinical outcomes of multiple-level symptomatic herniated thoracic discs. J Neurosurg Spine. 2013; 19 (6): 774-783.

12. Regev GJ, Salame K, Behrbalk E, et al. Minimally invasive transforaminal, thoracic microscopic discectomy: technical report and preliminary results and complications. Spine J. 2012; 12: 570-576.