scholarly journals Atypical Presentation of Thoracic Disc Herniation: Case Series and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Ali Shirzadi ◽  
Doniel Drazin ◽  
Sunil Jeswani ◽  
Leah Lovely ◽  
John Liu
Keyword(s):  
Disc Herniation ◽  
Case Series ◽  
Thoracic Disc Herniation ◽  
Lower Extremity Weakness ◽  
Delay In Diagnosis ◽  
Burning Pain ◽  
Presenting Symptoms ◽  
Asymptomatic Patients ◽  
Patient Reported ◽  
Thoracic Disc

Modern imaging has revealed that thoracic disc herniation (TDH) has a prevalence of 11–37% in asymptomatic patients. Pain, sensory disturbances, myelopathy, and lower extremity weakness are the most common presenting symptoms, but other atypical extraspinal complaints, such as gastrointestinal or cardiopulmonary discomfort, may be reported. Our objective is to make providers familiar with TDH’s atypical symptoms to help avoid potential serious consequences created by a delay in diagnosis. We report the cases of two patients who each presented with atypical extraspinal symptoms secondary to a TDH. One patient presented with a chronic history of nausea, emesis, and chest tightness and MRI showed a large right paramedian disc herniation at T7-8. A second patient reported chronic constipation, buttock and leg burning pain, gait instability, and urinary frequency; an MRI of his thoracic spine demonstrated a central disc herniation at T10-11. TDH can present with vague extraspinal symptoms and unfamiliarity with these symptoms can lead to misdiagnosis with progression of the disease and unnecessary diagnostic tests and medical procedures. Therefore, TDH should be included in the differential diagnosis of patients with negative gastrointestinal, genitourinary, and cardiopulmonary system basic studies.

scholarly journals Sleep Apnea and Unilateral Upper and Lower Extremity Allodynia as a Result of a Large Thoracic Disc Herniation: A Case Report

2021 ◽  
Author(s):  
Tyler D. Alexander ◽  
Anthony Stefanelli ◽  
Sara Thalheimer ◽  
Joshua E. Heller
Keyword(s):  
Spinal Cord ◽  
Sleep Apnea ◽  
Sexual Dysfunction ◽  
Lower Extremity ◽  
Disc Herniation ◽  
Cord Compression ◽  
Thoracic Disc Herniation ◽  
Lower Extremity Weakness ◽  
Disc Herniations ◽  
Thoracic Disc

Abstract BackgroundClinically significant disc herniations in the thoracic spine are rare accounting for approximately 1% of all disc herniations. In patients with significant spinal cord compression, presenting symptoms typically include ambulatory dysfunction, lower extremity weakness, lower extremity sensory changes, as well as bowl, bladder, or sexual dysfunction. Thoracic disc herniations can also present with thoracic radiculopathy including midback pain and radiating pain wrapping around the chest or abdomen. The association between thoracic disc herniation with cord compression and sleep apnea is not well described.Case PresentationThe following is a case of a young male patient with high grade spinal cord compression at T7-8, as a result of a large thoracic disc herniation. The patient presented with complaints of upper and lower extremity unilateral allodynia and sleep apnea. Diagnosis was only made once the patient manifested more common symptoms of thoracic stenosis including left lower extremity weakness and sexual dysfunction. Following decompression and fusion the patient’s allodynia and sleep apnea quickly resolved.ConclusionsThoracic disc herniations can present atypically with sleep apnea – a symptom which may resolve with surgical treatment.

scholarly journals Posterior Minimally Invasive Transpedicular Approach for Giant Calcified Thoracic Disc Herniation

2020 ◽  
pp. 219256822093327 ◽  
Author(s):  
Daniel Shedid ◽  
Zhi Wang ◽  
Ahmad Najjar ◽  
Sung-Joo Yuh ◽  
Ghassan Boubez ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Disc Herniation ◽  
Case Series ◽  
Thoracic Disc Herniation ◽  
Retrospective Case ◽  
Tubular Retractor ◽  
Posterior Surgery ◽  
Transpedicular Approach ◽  
Dural Tears ◽  
Thoracic Disc

Study Design: Retrospective case series. Objective: Posterior surgery for thoracic disc herniation was associated with increased morbidity and mortality and new minimally invasive approaches have been recommended for soft disc herniation but not for calcified central disc. The objective of this study is to describe a posterolateral microscopic transpedicular approach for central thoracic disc herniation. Methods: This is a single center retrospective review of all the cases of giant thoracic calcified disc herniation as defined by Hott et al. Presence of myelopathy, percentage of canal compromise, T2 hypersignal, ASIA score, and ambulatory status were recorded. This posterolateral technique using a tubular retractor was thoroughly described. Results: Eight patients were operated upon with a mean follow-up of 16 months. Mean canal compromise was 61%. Mean operative time was 228 minutes and mean operative bleeding was 250 mL. There were no cases of dural tear or neurologic degradation. Conclusion: This is the first report of posterior minimally invasive transpedicular approach for giant calcified disc herniation. There were neither cases of neurological deterioration nor increased rate of dural tears. This technique is thus safe and could be recommended for treatment of this rare disease.

scholarly journals Sleep apnea and unilateral upper and lower extremity allodynia as a result of a large thoracic disc herniation: a case report

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Tyler D. Alexander ◽  
Anthony Stefanelli ◽  
Sara Thalheimer ◽  
Joshua E. Heller
Keyword(s):  
Spinal Cord ◽  
Sleep Apnea ◽  
Sexual Dysfunction ◽  
Lower Extremity ◽  
Disc Herniation ◽  
Cord Compression ◽  
Thoracic Disc Herniation ◽  
Lower Extremity Weakness ◽  
Disc Herniations ◽  
Thoracic Disc

Abstract Background Clinically significant disc herniations in the thoracic spine are rare accounting for approximately 1% of all disc herniations. In patients with significant spinal cord compression, presenting symptoms typically include ambulatory dysfunction, lower extremity weakness, lower extremity sensory changes, as well as bowl, bladder, or sexual dysfunction. Thoracic disc herniations can also present with thoracic radiculopathy including midback pain and radiating pain wrapping around the chest or abdomen. The association between thoracic disc herniation with cord compression and sleep apnea is not well described. Case presentation The following is a case of a young male patient with high grade spinal cord compression at T7-8, as a result of a large thoracic disc herniation. The patient presented with complaints of upper and lower extremity unilateral allodynia and sleep apnea. Diagnosis was only made once the patient manifested more common symptoms of thoracic stenosis including left lower extremity weakness and sexual dysfunction. Following decompression and fusion the patient’s allodynia and sleep apnea quickly resolved. Conclusions Thoracic disc herniations can present atypically with sleep apnea. We recommend taking into consideration that sleep symptoms may resolve when planning treatment for thoracic disc herniation.

scholarly journals Full-Endoscopic Transforaminal Ventral Decompression for Symptomatic Thoracic Disc Herniation with or without Calcification: Technical Notes and Case Series

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Shangju Gao ◽  
Jingchao Wei ◽  
Wenyi Li ◽  
Long Zhang ◽  
Can Cao ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Disc Herniation ◽  
Average Length ◽  
Case Series ◽  
Operation Time ◽  
Leg Pain ◽  
Thoracic Disc Herniation ◽  
Open Operation ◽  
Thoracic Disc

Background. Symptomatic thoracic disc herniation is a challenge in spinal surgery, especially for cases with calcification. Traditional open operation has a high complication rate. The authors introduced a modified full-endoscopic transforaminal ventral decompression technique in this study and evaluated its imaging and clinical outcomes. Materials and Methods. Eleven patients with symptomatic thoracic disc herniation who underwent full-endoscopic transforaminal ventral decompression in a single medical center were enrolled. The surgical technique was performed as described in detail. Dilator sliding punching, endoscope-monitored foraminoplasty, and base cutting through the “safe triangle zone” are the key points of the technique. Clinical outcomes were assessed by the modified Japanese Orthopedic Association (mJOA) score for neurological improvement and the visual analogy score (VAS) for thoracic and leg pain. The operation time, hospital stay, and complications were also analyzed. Results. Postoperative magnetic resonance imaging (MRI) revealed good decompression of the spinal cord. The mJOA improved from 7.4 (range: 5–10) to 10.2 (range: 9–11). Axial thoracic pain improved in 8 of 9 patients. Leg pain and thoracic radicular pain improved in all patients. No complications were observed. The average operation time was 136 minutes (range: 70–180 minutes). The average length of hospital stay was 5.3 days (range: 2–8 days). Conclusion. Minimally invasive full-endoscopic transforaminal ventral decompression for the treatment of symptomatic thoracic disc herniation with or without calcification is feasible and may be another option for this challenging spine disease.

Transdural Spinal Cord Herniation: An Exceptional Complication of Thoracoscopic Discectomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Benjamin Pommier ◽  
Michaël Grelat ◽  
Rostom Messerer ◽  
Sylvain Portet ◽  
Cédric Y Barrey
Keyword(s):  
Spinal Cord ◽  
Lower Extremity ◽  
Disc Herniation ◽  
Posterolateral Approach ◽  
Thoracic Disc Herniation ◽  
Lower Extremity Weakness ◽  
Initial Surgery ◽  
Spinal Cord Herniation ◽  
Dural Tears ◽  
Thoracic Disc

Abstract Thoracic disc herniation is a rare and severe condition, whose treatment may have complications including dural tears. Although benign in most cases, dural tears may induce iatrogenic transdural herniation of the spinal cord. The video demonstrates the diagnosis and surgical treatment of iatrogenic transdural herniation of the spinal cord. Here, we report a case of spinal cord herniation after thorascopic treatment of a thoracic disc herniation (DH). A 28-yr-old male presented with several years of left lower extremity weakness and was found to have a T6-7 DH. He underwent DH resection through video assisted mini-thoracotomy at another institution. In the immediate postoperative period, he developed a Brown-Sequard syndrome with left leg weakness. The surgeon decided not to reoperate and the patient improved with rehabilitation, allowing him to walk again. At 6 mo postop, he experienced sudden neurologic worsening but did not present to our clinic until 6 mo later. At this time, he had near complete paraplegia with bilateral lower extremity spasticity and central neuropathic pain. MRI showed a pseudo-meningocele and features suggesting a lateral spinal cord herniation. After a multidisciplinary meeting, we elected to perform a posterolateral approach with costo-arthro-pediculectomy and durotomy to repair the SC herniation. Immediately postop, the patient had a slight improvement in right lower extremity function, with decreased pain and spasticity. This case shows a transdural SC herniation, a rare complication after resection of DH. It is possible that an unreported or unrecognized dural tear at the time of the initial surgery, combined with the negative pressure of the thoracic cavity, put the patient at risk for this particular complication. The authors state that the patient gave his informed consent.

scholarly journals Thoracic intramedullary neurosarcoidosis with thoracic disc herniation: Diagnostic importance of intramedullary contrast enhancement

2021 ◽  
Vol 12 ◽  
pp. 331
Author(s):  
Justin Beiriger ◽  
Hussam Abou-Al-Shaar ◽  
Hansen Deng ◽  
Mansour Mathkour ◽  
David O. Okonkwo
Keyword(s):  
Spinal Cord ◽  
Contrast Enhancement ◽  
Disc Herniation ◽  
Mediastinal Lymphadenopathy ◽  
Thoracic Disc Herniation ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Radiographic Findings ◽  
Signal Change ◽  
Thoracic Disc

Background: Thoracic intramedullary neurosarcoidosis is an uncommon but serious manifestation of spinal cord disease. Its concomitant occurrence with thoracic disc herniation can mislead the physician into attributing neurologic and radiographic findings in the spinal cord to disc pathology rather than inflammatory disorder. Here, we present such a rare case of concomitant thoracic disc and spinal neurosarcoidosis. Case Description: A 37-year-old male presented with progressive right lower extremity weakness and numbness. Magnetic resonance imaging (MRI) of the thoracic spinal cord revealed a T6-T7 paracentral disc eccentric to the right with T2 signal change extending from T2 to T10 level. This prompted acquiring a contrasted MRI that also depicted intramedullary enhancement around the T6-T7 disc bulge. Computed tomography scan of the chest showed mediastinal lymphadenopathy concerning for sarcoidosis. Lymph node biopsy confirmed the diagnosis of sarcoidosis, and high-dose steroid treatment was initiated. The patient had significant symptomatic improvement with steroids with full neurological recovery and improvement of his symptoms. Conclusion: While stenosis from thoracic disc disease could potentially suggest a mechanical etiology for the patient’s symptoms, attention must be paid to the imaging findings as well as the degree and extent of cord signal change and intramedullary contrast enhancement. Appropriate and timely diagnosis is essential to avoid unnecessary invasive procedures.

Transforaminal Endoscopic Foraminoplasty and Discectomy for the Treatment of a Thoracic Disc Herniation

2016 ◽  
Vol 90 ◽  
pp. 194-198 ◽  
Author(s):  
Ralf Wagner ◽  
Albert E. Telfeian ◽  
Menno Iprenburg ◽  
Guntram Krzok ◽  
Ziya Gokaslan ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Thoracic Disc Herniation ◽  
Thoracic Disc

scholarly journals PATH-18. A MULTI-CENTER CASE SERIES OF ADULT K27M MUTATED DIFFUSE MIDLINE GLIOMAS REVEALING A POPULATION UNIQUE FROM PAEDIATRIC CASES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii167-ii168
Author(s):  
Alexander Yuile ◽  
Madhawa De Silva ◽  
Marina Kastelan ◽  
Veronica Cheung ◽  
Joanne Sy ◽  
...  
Keyword(s):  
Older Patients ◽  
Selection Criteria ◽  
Case Series ◽  
Progression Free Survival ◽  
Paediatric Population ◽  
Asia Pacific ◽  
Royal North Shore Hospital ◽  
Free Survival ◽  
Delay In Diagnosis ◽  
Presenting Symptoms

Abstract BACKGROUND Histone mutations in the K27M gene were first described in 2014, and incorporated into the WHO CNS tumour classification system in 2016. They are typically associated with diffuse midline gliomas (DMG). Presenting symptoms vary greatly, with some experiencing significant delay in diagnosis. Median survival is only 9-12 months for these patients. Biopsy samples are small, and in some due to location, not performed. Although data is predominately based on the paediatric population, DMGs are seen in both adolescence and adults. In this multi-site retrospective study, we describe 11 adult patients with K27M DMG gliomas across two tertiary Neuro-Oncology services in Sydney, Australia. To the authors’ knowledge we present the largest known collection of adult K27M cases in the Asia-Pacific region with correlation of treatment, clinicopathologic and radiologic features with outcomes. METHODS The glioma databases of Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) between January 2009 and March 2020 were interrogated to identify patients. Selection criteria included patients aged ≥ 18 years who presented with a DMG, had undergone biopsy, and had confirmed K27M via next generation sequencing. Clinicopathologic, radiologic and treatment outcomes were extracted for correlation. RESULTS Eleven patients fitting the selection criteria were identified and reported. The median age at diagnosis was 30 years and 4 were female. Five presented with hydrocephalus, the most common presenting symptoms were headaches and nausea and/or vomiting (n= 4 and n= 2 respectively). The median progression-free survival was 13 months (4-31 months) and the median overall survival was 23 months (4-59 months). CONCLUSION This case series reports the outcomes of older patients with K27M. The clinical course demonstrated suggests a divergence from paediatric biology. Ongoing studies are required to further characterise the histopathological and clinical differences of these tumours in older patients.

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