scholarly journals Spontaneous regression and near disappearance of a calcified herniated thoracic disc in a 44-year-old male: illustrative case

2021 ◽  
Vol 1 (19) ◽  
Author(s):  
Andrew Utter ◽  
David Cavanaugh ◽  
Kelly F. Van Schouwen ◽  
Madison Mascagni ◽  
Madeline Walker ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Conservative Treatment ◽  
Thoracic Spine ◽  
Neurological Deficit ◽  
Spontaneous Regression ◽  
Illustrative Case ◽  
Rare Occurrence ◽  
Invasive Treatment ◽  
Thoracic Disc ◽  
Herniated Discs

BACKGROUND Herniation of an intervertebral disc (IVD) is found predominantly in the lumbar and cervical spine of both children and adults, but herniated IVDs of the thoracic spine are a rare occurrence. However, approximately 40% of herniated thoracic disc cases are calcified. Approximately 0.65% of all spinal herniations are calcified herniated thoracic discs (CHTDs). CHTDs can be treated conservatively or invasively, depending on the symptoms and degree of neurological deficit present. OBSERVATIONS The authors report a 44-year-old male with near complete reabsorption and disappearance of a CHTD. A review of the available literature indicates that there are only seven adult patients in whom this phenomenon has been reported. LESSONS Determining the best form of invasive treatment is a challenge for surgeons given the complexity of this condition. While the disappearance of calcified herniated discs of the lumbar and cervical spine has been reported, reports of the regression of CHTDs are rare. The disappearance of CHTDs is more commonly reported in children who undergo conservative treatment, while surgery is reserved for children who experience progressive pain and neurological deficit. Given the success of conservative treatment of CHTDs in children, conservative treatment methods should be considered when treating mildly symptomatic adults.

Thoracic spinal disease

2019 ◽  
pp. 711-718
Author(s):  
Kieron Sweeney ◽  
Catherine Moran ◽  
Ciaran Bolger
Keyword(s):  
Cervical Spine ◽  
Thoracic Spine ◽  
Osteoporotic Fractures ◽  
Biomechanical Properties ◽  
Minimally Invasive Techniques ◽  
Disc Prolapse ◽  
Disc Disease ◽  
Thoracic Spinal ◽  
Thoracic Disc ◽  
Invasive Techniques

The thoracic spine occupies a unique position with respect to anatomical, biomechanical, pathological, and surgical considerations. The kyphosis of the thoracic spine is offset by the lordosis in the mobile cervical spine and the principal load bearing lumbar spine maintaining a sagittal balanced posture. Due to the biomechanical properties of the thoracic spine, the incidence of thoracic disc prolapse is low. However, the anatomical features of the thoracic spine make appropriate surgical planning imperative. This chapter will cover the management and operative approaches to thoracic disc disease, including open and minimally invasive techniques. Operative approaches can be broadly divided into two groups, anterior and posterior-lateral. Each approach is discussed with respect to technique, anatomy, closure, and common complications. It will also discuss pathogenesis, diagnosis, and management of osteoporotic fractures.

scholarly journals Spontaneous Regression after Extensive Recurrence of a Pediatric Cervical Spine Aneurysmal Bone Cyst

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Carlo Brembilla ◽  
Luigi Andrea Lanterna ◽  
Michela Bosisio ◽  
Paolo Gritti ◽  
Andrea Risso ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Local Recurrence ◽  
Aneurysmal Bone Cyst ◽  
Neurological Deficit ◽  
Spontaneous Regression ◽  
Bone Cyst ◽  
Young Girl ◽  
Complete Regression ◽  
Aneurismal Bone Cyst ◽  
Mri Scans

Aneurysmal bone cyst is a pseudotumoral lesion. Complete resection prior to selective arterial embolization seems to be the treatment of choice for the more extensive and destructive lesions. In these cases maintaining stability of the cervical spine is critical. This can be very challenging in children and adolescents in whom the axial skeleton is still growing. In this case a young girl presented with a voluminous cervical aneurysmal bone cyst encaging both vertebral arteries and spinal cord. The lesion was treated with aggressive surgical resection, followed by cervical vertebral fusion with instrumentation. After nine months the patient referred no pain and no neurological deficit. MRI scans showed an extensive local recurrence. The family of the young girl refused any other therapy and any other followup. The patients returned to our attention after five years with no pain and neurological deficit. Cervical spine radiographs and MRI scans showed a complete regression of the extensive local recurrence. In the literature, the possibility of spontaneous regression of residual part or local recurrence is reported. The case of this young girl provided the chance to attend a spontaneous regression in an extensive recurrence of aneurismal bone cyst.

Resorption of thoracic disc herniation

2008 ◽  
Vol 8 (3) ◽  
pp. 300-304 ◽  
Author(s):  
Hirotaka Haro ◽  
Toru Domoto ◽  
Shingo Maekawa ◽  
Tadahiro Horiuchi ◽  
Hiromichi Komori ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Disc Herniation ◽  
Bladder Dysfunction ◽  
Herniated Disc ◽  
Prostaglandin E ◽  
Muscular Weakness ◽  
Thoracic Disc Herniation ◽  
Disc Herniations ◽  
Thoracic Disc ◽  
Herniated Discs

✓The authors describe 2 cases of thoracic disc herniation, resulting in acute myelopathy without bladder dysfunction or progressive muscular weakness; the herniated disc apparently resorbed without surgical intervention. Thoracic disc herniations are less frequent than cervical or lumbar disc herniations and are usually associated with severe neurological deficits. In these 2 cases, the herniated discs exhibited marked decreases in size, corresponding to a favorable clinical outcome within a few months after the initiation of conservative treatment with prostaglandin E1 and/or steroids in conjunction with physical therapy. The authors conclude that thoracic herniated discs are capable of undergoing natural resorption and that conservative treatment could be indicated, even in the presence of moderate myelopathy, when the myelopathy is not accompanied by bladder dysfunction or progressive muscular weakness.

Occipitocervicothoracic stabilization in pediatric patients

2011 ◽  
Vol 8 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Kyle M. Fargen ◽  
Richard C. E. Anderson ◽  
David H. Harter ◽  
Peter D. Angevine ◽  
Valerie C. Coon ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Thoracic Spine ◽  
Pediatric Patients ◽  
Pathological Condition ◽  
Case Series ◽  
Neurological Function ◽  
Spinal Reconstruction ◽  
Spine Deformities ◽  
Distal Fixation

Object Although rarely encountered, pediatric patients with severe cervical spine deformities and instability may occasionally require occipitocervicothoracic instrumentation and fusion. This case series reports the experience of 4 pediatric centers in managing this condition. Occipitocervical fixation is the treatment of choice for craniocervical instability that is symptomatic or threatens neurological function. In children, the most common distal fixation level with modern techniques is C-2. Treated patients maintain a significant amount of neck motion due to the flexibility of the subaxial cervical spine. Distal fixation to the thoracic spine has been reported in adult case series. This procedure is to be avoided due to the morbidity of complete loss of head and neck motion. Unfortunately, in rare cases, the pathological condition or highly aberrant anatomy may require occipitocervical constructs to include the thoracic spine. Methods The authors identified 13 patients who underwent occipitocervicothoracic fixation. Demographic, radiological, and clinical data were gathered through retrospective review of patient records from 4 institutions. Results Patients ranged from 1 to 14 years of age. There were 7 girls and 6 boys. Diagnoses included Klippel-Feil, Larsen, Morquio, and VATER syndromes as well as postlaminectomy kyphosis and severe skeletal dysplasia. Four patients were neurologically intact and 9 had myelopathy. Five children were treated with preoperative traction prior to instrumentation; 5 underwent both anterior and posterior spinal reconstruction. Two patients underwent instrumentation beyond the thoracic spine. Allograft was used anteriorly, and autologous rib grafts were used in the majority for posterior arthrodesis. Follow-up ranged from 0 to 43 months. Computed tomography confirmed fusion in 9 patients; the remaining patients were lost to follow-up or had not undergone repeat imaging at the time of writing. Patients with myelopathy either improved or stabilized. One child had mild postoperative unilateral upper-extremity weakness, and a second child died due to a tracheostomy infection. All patients had severe movement restriction as expected. Conclusions Occipitocervicothoracic stabilization may be employed to stabilize and reconstruct complex pediatric spinal deformities. Neurological function can be maintained or improved. The long-term morbidity of loss of cervical motion remains to be elucidated.

Predictors of Recovery After Conservative Treatment of AO-Type A Thoracolumbar Spine Fractures Without Neurological Deficit

Spine ◽  
2018 ◽  
Vol 43 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Peter Vorlat ◽  
Geert Leirs ◽  
Farhad Tajdar ◽  
Heinz Hulsmans ◽  
Hugo De Boeck ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Neurological Deficit ◽  
Thoracolumbar Spine ◽  
Type A ◽  
Spine Fractures ◽  
Thoracolumbar Spine Fractures

Spontaneous Regression of Disc Prolapse – An Underlooked Phenomena: A Case Report and Literature Review

2021 ◽  
pp. 48
Author(s):  
Majd Alrayes
Keyword(s):  
Back Pain ◽  
Case Report ◽  
Conservative Management ◽  
Spontaneous Regression ◽  
Neurological Deficits ◽  
Herniated Disc ◽  
Medical Illness ◽  
Disc Prolapse ◽  
Disk Prolapse ◽  
Herniated Discs

Introduction: Intervertebral disc prolapse is a very common abnormality found in the population, that can manifest in a variety of complaints like back pain, radiculopathy, and even to the extent that it might lead to more adverse neurological deficits. Symptoms improve in majority of patients only with conservative treatment. However, some patients may require surgical intervention. In some cases, spontaneous regression of herniated disc can be seen. Thus, the interest in the phenomenon of spontaneous resorption of the herniated discs has increased, which raised the controversy regarding managing such patients. Here, we report a case of a huge lumbosacral spontaneous disc resolution at the level of L5-S1 in which clinical improvement was associated with a significant decrease in the size of a huge, herniated disc. In addition, we performed a comprehensive review of literature of all reported cases of spontaneous disc resolution to provide an updated discussion of such an underlooked phenomena. Case Report: A 53-year-old female not known to have any medical illness presented at the Neurosurgery Clinic with complaints of chronic back pain for six years which was progressing and radiating to both of her lower extremities (right more than left) and had become more intense in the last year. It was slightly relieved by simple analgesics and aggravated by sitting or lying down. There was no history of trauma, weaknesses, or sphincteric disturbances. Upon evaluation in our clinic, local exam revealed lower back midline tenderness at the level of L5-S1 vertebrae. No tenderness was observed in the paravertebral area or facets. Straight leg raising test was positive at 70º in the right side and 90º in the left, normal power, intact sensation, normal tone, and reflexes. Negative Babinski and clonus was noted in both limbs. MRI lumbar spine showed significant right paracentral L5-S1 disk prolapse indenting the thecal sac compressing the root. A full-course and effective medical treatment was initiated as the patient was never treated properly before for her back pain, along with physical therapy and regular OPD follow-ups. A follow-up MRI a year later revealed significant reduction in the size of the disk prolapse as compared to the initial imaging study. Overall, patient’s symptoms significantly improved, and she was kept on conservative management. Conclusion: To conclude, the case presented here shows the efficacy and validity of conservative management for patients who are diagnosed with a herniated disc in the absence of neurological deficits. This shows the importance of not pushing surgical treatment for patient with lumbar disc herniation without neurological deficits, each patient should receive a trial of conservative therapy and close OPD follow-ups and repeated MRI scans for further assessment of any advancement or improvement, because herniated discs can regress spontaneously. Radiological changes alone should not be the main target for assessing improvement, what matters more is clinical and symptomatic improvement. Surgical management remains an important therapeutic option for patients who failed conservative management and patients who have severe neurological deficits.

Characteristics and Factors Associated With Spontaneous Regression of Extruded Lumbar Disc Herniation: A Retrospective Analysis of 31 Cases

2021 ◽  
Author(s):  
Qing-Guang Qin ◽  
Jia Liu ◽  
Li-Jing Zhao ◽  
Shuai Yuan ◽  
Fang Feng ◽  
...  
Keyword(s):  
Linear Regression ◽  
Multiple Linear Regression ◽  
Acute Phase ◽  
Lumbar Disc Herniation ◽  
Spontaneous Regression ◽  
Lumbar Disc ◽  
Bed Rest ◽  
Factors Associated ◽  
Herniated Discs ◽  
Rehabilitation Exercise

Abstract BackgroundLumbar disc herniation (LDH) is a common condition leading to high individual, social, and economic impacts. Reported rates of spontaneous resorption of LDH vary from 35% to 100%; however, it remains unclear how spontaneous absorption, rather than re-protrusion, can be maximized.Purpose The main objective of this study was to determine the characteristics and factors enabling for spontaneous regression of extruded LDH. DesignA retrospective single center case series. Patient sampleInpatients (n = 33) with LDH who experienced spontaneous regression between September 2015 and June 2020. Outcome measuresQuestionnaire responses and magnetic resonance imaging (MRI)-determined hernia regression.MethodsA questionnaire was distributed to patients to assess factors associated with hernia resorption, the volume of herniated intervertebral discs evaluated by MRI, and the absorption ratio calculated. Multiple linear regression was used to explore factors enabling spontaneous herniated disc regression. ResultsA total of 31 patients received a mean of 5.90 conservative treatments during hospitalization, and 1.91 during rehabilitation. Of patients, 90.32% underwent bed-rest during the acute phase of the disease, and 61.29% did so during rehabilitation. Rehabilitation exercise was undertaken by 93.55% of patients, with a mean of 2.42 exercise methods per patient. Waist lumbosacral orthosis devices were worn by 80.65% of patients. Multiple linear regression showed that bed-rest days in the acute phase (X1), herniation type (X2), time wearing lumbosacral orthosis (X3), onset-treatment duration (X4), and days of bed-rest days in rehabilitation (X5) had significant effects on the spontaneous regression ratio (y) of herniated discs (all P < 0.05). The optimal linear regression equation was y = 0.616 + 0.497X1 – 0.478X2 + 0.384X3 – 0.343X4 – 0.241X5. Conclusions Our findings support that patients with extruded or sequestered LDH should receive comprehensive treatment. Early treatment, early bed-rest, and lumbosacral orthosis protection promote the spontaneous regression of herniated discs; however, bed-rest during rehabilitation is a poor prognostic factor. Adherence to rehabilitation exercise will be beneficial to the recovery of patients with LDH.

scholarly journals Acute thoracic disc heralded by change in spinal cord stimulation pattern: illustrative case

2021 ◽  
Vol 2 (20) ◽  
Author(s):  
Faraz Behzadi ◽  
Edvin Telemi ◽  
Tarek R. Mansour ◽  
Thomas M. Zervos ◽  
Muwaffak M. Abdulhak ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
Chronic Back Pain ◽  
Cord Compression ◽  
Illustrative Case ◽  
Disc Protrusion ◽  
Stimulation Parameters ◽  
Spine Pathology ◽  
Thoracic Disc

BACKGROUND Spinal cord stimulation (SCS) uses unique electric stimulation parameters to selectively treat specific regions of chronic or refractory back pain. Changing these parameters can lead to spreading paresthesia and/or pain beyond the desired region. OBSERVATIONS A patient with a history of stable, successful SCS treatment presented with acute development of paresthesias that were relieved by reduction of stimulation parameters. The patient required paradoxically lower SCS settings for control of chronic back pain. This presentation prompted further investigation, which revealed a new disc protrusion and cord compression at the level of the paddle lead. LESSONS In patients with SCS, a new onset of back pain accompanied by acute paresthesia that is reversible by reducing the SCS amplitude warrants investigation for new spine pathology.

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