Bhandutia Amit K, Zuzek Zachary, Schessler Matthew J, Tomycz Nestor D, Altman Daniel T
Departments of Orthopaedic Surgery (A.K.B., M.J.S., and D.T.A.) and Neurosurgery (N.D.T.), Allegheny General Hospital, Pittsburgh, Pennsylvania.
Drexel University College of Medicine, Philadelphia, Pennsylvania.
JBJS Case Connect. 2017 Jan-Mar;7(1):e4. doi: 10.2106/JBJS.CC.16.00106.
A 29-year-old man presented with right medial arm pain with paresthesia, as well as right-sided ptosis, miosis, and anhidrosis. Magnetic resonance imaging revealed a right paracentral disc herniation at the T1-T2 level. The patient underwent a hemilaminectomy with a medial facetectomy through a posterolateral approach to the T1-T2 disc space, followed by a discectomy. Intraoperative findings were notable for a conjoined nerve root.
Although high thoracic disc herniation is rare, its diagnosis should be considered when patients present with radicular arm pain and Horner syndrome. A high index of suspicion should be maintained for nerve root anomalies to limit iatrogenic injury and to ensure successful decompression.
一名29岁男性出现右臂内侧疼痛伴感觉异常，以及右侧上睑下垂、瞳孔缩小和无汗。磁共振成像显示T1 - T2水平右侧中央旁椎间盘突出。患者通过后外侧入路对T1 - T2椎间盘间隙进行了半椎板切除术和内侧小关节切除术，随后进行了椎间盘切除术。术中发现有联合神经根。
虽然高位胸椎椎间盘突出罕见，但当患者出现臂部放射性疼痛和霍纳综合征时，应考虑其诊断。对于神经根异常应保持高度怀疑，以限制医源性损伤并确保成功减压。
