Abstract
We present a rare case of a patient initially presenting with unilateral abdominal wall bulging and radicular pain caused by a lateral disc herniation at Th11/12, later suffering from a hernia recurrence with bilateral disc prolapse and motor deficits. The patient underwent sequesterectomy via a right hemilaminectomy at Th11, and after 8 weeks, a bilateral sequesterectomy with semirigid fusion Th11/12 was performed. Unilateral motor deficits at the thoracic level have been discussed in case reports; a bilateral disc protrusion with abdominal wall bulging occurring as a recurrent disc herniation has never been described before.
Highlights
While lumbar disc herniation present a very common pathology in patients between 30 and 50 years of age with an incidence of 5 to 20 cases per 1000 adults annually [6], thoracic disc herniation occurs more rarely [2, 16] and accounts for less than 4% of the surgeries performed [2].Compared to cervical and lumbar disc protrusions, thoracic disc herniation seldom causes symptoms
We hereby present a rare case of a patient initially presenting with unilateral abdominal pain and abdominal wall hernia, with complete neurophysiological assessment, intraoperative imaging, and postoperative outcome, who later developed a bilateral recurrent disc protrusion with bilateral radiculopathy and symmetrical abdominal wall bulging due to muscle paresis
Patients may confound the abdominal pain with visceral pathologies, which is more common than disc prolapses causing the symptoms
Summary
While lumbar disc herniation present a very common pathology in patients between 30 and 50 years of age with an incidence of 5 to 20 cases per 1000 adults annually [6], thoracic disc herniation occurs more rarely [2, 16] and accounts for less than 4% of the surgeries performed [2]. Symptomatic thoracic disc herniation mainly causes signs of myelopathy (50 to 80%) [7, 8, 14], thoracic or abdominal radiculopathy and abdominal pain [1, 15], or, in rare cases, anterior spinal artery syndrome [17]. An 81-year-old patient presented with sudden onset bulging of his right abdominal wall (Fig. 1) and radicular pain projected to the Th11 dermatome. An MRI of the thoracic and lumbar spine was performed, showing a large disc prolapse at the Th11/12 level on the right side affecting the right Th11 nerve root (Fig. 3). Except for the right abdominal wall bulging and radicular pain projecting on the Th11 nerve root, no focal neurological deficit could be detected. Back pain resolved after the operative treatment; the bilateral abdominal wall bulging remained stable (follow-up 5 months)
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