Picado-Baca Mauricio Leonardo, Mireles-Cano José Nicolás, León-Meza Víctor Manuel, García-González Oscar Guillermo, Ramos-Trujillo Alejandro
Departamento de Neurocirugía y Unidad de Cirugía de Columna, Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México.
Departamento de Neurocirugía y Unidad de Cirugía de Columna, Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México.
Cir Cir. 2016 Sep-Oct;84(5):415-9. doi: 10.1016/j.circir.2015.11.001. Epub 2015 Dec 28.
Herniated thoracic intervertebral disc is a rare cause of spinal cord compression. Its frequency varies from 0.15% to 1.7% of all disc herniations, and produces symptoms in 0.5% to 0.8%.
Case 1. A 50-year-old woman, with pain and burning sensation in left hemithorax of four months of onset. It was treated as a herpetic syndrome, with no improvement. She was seen after thirteen days of exacerbation of clinical symptoms. The physical examination showed asymmetric paraparesis, lower left pelvic limb 1/5, and right pelvic limb 3/5¸ sensory level T8, with left Babinski positive. A thoracic disc herniation in space T8-T9 was diagnosed.
CASE 2: A 55-year-old patient with a history of presenting pain in lumbar area of 5 years onset. She also had radicular pain that radiated to the right pelvic limb, with intensity 10/10 on a Visual Analogue Scale. Her physical examination showed muscle strength 5/5, with normal sensitivity in all dermatomes and tendon reflexes, and a positive right Babinski. Thoracic disc herniation T7-T8 level was diagnosed.
Due to anatomical conditions that define this type of hernia, the extracavitary posterolateral approach should be the recommended surgical procedure when the simultaneously performed anterior decompression and fixation with posterior instrumentation are the treatments proposed.
Despite the different anatomical structures of this special area, it was possible to obtain satisfactory results for both clinical cases.
胸椎间盘突出是脊髓压迫的罕见原因。其发生率在所有椎间盘突出中占0.15%至1.7%，出现症状的比例为0.5%至0.8%。
病例1。一名50岁女性，左半胸疼痛和烧灼感发作4个月。最初按疱疹综合征治疗，无改善。临床症状加重13天后前来就诊。体格检查显示不对称性轻瘫，左下肢肌力1/5，右下肢肌力3/5，感觉平面T8，左侧巴宾斯基征阳性。诊断为T8 - T9节段胸椎间盘突出。
病例2：一名55岁患者，腰部疼痛5年。她还伴有放射至右下肢的神经根性疼痛，视觉模拟评分强度为10/10。体格检查显示肌力5/5，所有皮节感觉及腱反射正常，右侧巴宾斯基征阳性。诊断为T7 - T8节段胸椎间盘突出。
鉴于这种类型疝的解剖情况，当建议同时进行前路减压和后路器械固定治疗时，腔外后外侧入路应是推荐的手术方法。
尽管该特殊区域解剖结构不同，但两个临床病例均取得了满意结果。
