Thoracic intervertebral disc protrusion with spinal cord compression.

Abstract

S INCE the original report of Middleton and Teacher in 191 I, 20 the sinister sequelae of central thoracic disc protrusion, operated or unoperated, have been increasingly appreciated. 1-4,~,9-11,15,16,19,~,22 Their patient lifted a heavy steel plate, rapidly became paraplegic, and died. Necropsy disclosed a massive disc protrusion opposite the twelfth thoracic interspace. Of Muller's 22 four cases, after operation three were left with an almost complete transection of the cord, and the fourth, after a slight, temporary improvement, with a total paraplegia. Of Hawk's 9 three patients who survived operation, all with severe preoperative spinal cord damage, one was made worse and the others showed no benefit from surgery. Two of the four cases reported by Mixter and Barr 21 became paraplegic postoperatively. Of the 17 cases of Love and Kiefer, 17 marked improvement in the sensory and motor impairment occurred in only one, and complete recovery in none. Usually the patients with compression of the cord prior to operation had residual disability indicative of irremediable damage to the cord. Of Logue's x6 11 cases, the three severely disabled prior to operation developed a total transsection postoperatively. In the first the prolapse was excised, but in the other two surgical intervention was confined to a decompression. Two patients showing degenerative changes in the cord at operation, and one with a preoperative paraplegia, were rendered worse by removal of the protrusion and then