Acute noncontiguous multiple-level thoracic disc herniations with myelopathy: a case report.

STUDY DESIGN

The case report of a 38-year-old man with a unique acute, triple-level, noncontiguous thoracic disc herniation (T6, T9-T10, and T11-T12), delayed onset of lower limb weakness, paresthesias below the T10 dermatome, and urinary dysfunction following minor trauma resulting from a motorcycle accident.

OBJECTIVES

To present an unusual case of herniation that could involve ambiguous test results (imaging findings not necessarily correlated with severity of clinical manifestations).

SUMMARY OF BACKGROUND DATA

Multiple-level symptomatic disc herniations of the thoracic spine are rare, and the reported cases are mostly of contiguous, two-level lesions with chronic clinical presentation. No case of acute three-level noncontiguous ruptured thoracic disc herniations with myelopathy has been reported.

METHODS

Through the left transthoracic approach, partial corpectomy, complete discectomy, and interbody fusion of the T9-T10 vertebrae were performed. The less prominent lesions of the T6 and T12-L1 vertebrae were left untreated.

RESULTS

Remarkable improvement of neurologic symptoms, including motor weakness and bladder dysfunction, was observed 1 week after operation. At 1-year follow-up, he could walk without aid and with a somewhat spastic gait. However, paresthesias below dermatome T12 persisted. The patient refused to accept the recommendation of further surgical decompression of the nerves at the T6 and T12-L1 vertebral lesions.

CONCLUSION

Since the presentation of thoracic disc herniation is variable and difficult to correlate with imaging findings, decompression at all lesion levels in a patient with symptomatic multiple-level ruptured thoracic disc herniations may be necessary to achieve complete symptom relief and satisfactory results.