[Lower thoracic disc herniation with acutely developed vesicorectal dysfunction: case report].

Thoracic disc herniation is a rare and slowly progressive disease which most commonly occurs at the lower thoracic spine without any preceding trauma. We reported a case with acutely developed vesicorectal dysfunction due to a ruptured disc at Th 11-12. This symptom disappeared soon after disc removal via the transpedicular approach combined with transversectomy. This 45-year-old woman suddenly suffered, without previous trauma, from severe back pain radiating down to the posterior thighs. Since difficulty in urination and defecatory incontinence succeeded two days later, she was transferred to our hospital. Neurological examination on admission revealed anesthesia below S1, hypotonic bladder with almost perfectly preserved urinary sensation, complete lack of anal reflex, and only weak motor function in the lower extremities. Both knee and ankle jerks were diminished bilaterally. A herniated disc was initially suspected at L5-S1 on the MRI, but denied by both myelography and CT myelography. These studies showed a disc hernia compressing the cord at Th 11-12 on the left side. Since the hernia was located centrolaterally, we employed the transpedicular approach. To make removal of the more centrally located hernia easier, we further added transversectomy of the twelfth vertebra. This hernia was successfully removed under the operating microscope without further damage to the cord being incurred. We did not perform any instrumental fixation, because we thought preservation of the rib and costvertebral joint could contribute to the stability of the spine. Her vesicorectal symptom subsided immediately after the operation. She was free of any symptoms except for the remaining mild perianal numbness a year and seven months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)