Utter Andrew, Cavanaugh David, Van Schouwen Kelly F, Mascagni Madison, Walker Madeline, Stone Marcus
Spine Institute of Louisiana, Shreveport, Louisiana.
J Neurosurg Case Lessons. 2021 May 10;1(19):CASE2130. doi: 10.3171/CASE2130.
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.
背景:椎间盘突出主要见于儿童和成人的腰椎和颈椎,但胸椎椎间盘突出较为罕见。然而,约40%的胸椎椎间盘突出病例会发生钙化。所有脊柱突出病例中约0.65%为钙化性胸椎椎间盘突出(CHTD)。CHTD可根据症状和神经功能缺损程度进行保守或侵入性治疗。 观察结果:作者报告了一名44岁男性,其CHTD几乎完全吸收并消失。对现有文献的回顾表明,仅有7例成年患者报告了这一现象。 经验教训:鉴于这种情况的复杂性,确定最佳的侵入性治疗方式对外科医生来说是一项挑战。虽然已有腰椎和颈椎钙化性椎间盘突出消失的报道,但CHTD消退的报道很少。CHTD消失在接受保守治疗的儿童中更为常见,而手术则适用于出现进行性疼痛和神经功能缺损的儿童。鉴于儿童CHTD保守治疗的成功,在治疗症状较轻的成人时应考虑保守治疗方法。
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