Upper thoracic disc herniation followed by acutely progressing paraplegia

Abstract

Case report. To report a rare thoracic intervertebral disc herniation followed by acutely progressing paraplegia. Spinal Injuries Center, Fukuoka, Japan. A 37-year-old man presented with sudden severe backache and acutely progressing motor impairments of both lower extremities after antecedent backache lasting about 5 days. Neurological examination showed analgesia and hypoesthesia below the T4 dermatome level, dysesthesia to pinprick below right inguinal level, and severe motor impairments of the lower extremities (Frankel classification C). Magnetic resonance (MR) imaging demonstrated spinal cord compression due to a postero-laterally existing epidural mass at the T2-T3 level. After laminectomy at the T2-T3 level, the sequestrated disc material was detected and excised as one piece through the right side of the dura. The excised herniated mass had a ring-like form and was thought to originate from the annulus fibrosis. After the emergency surgery, he had complete relief from the backache and control of both lower extremities recovered gradually. At 4 weeks after the emergent operation, motor power of both lower extremities recovered almost completely. He was able to walk without any assistance. MR imaging study after surgery did not reveal the sequestrated mass, except for a mild disc bulging at the T2-T3 level. Accurate diagnosis of acute symptomatic thoracic disc herniation is occasionally difficult. However, timely and successful surgery could result in complete symptom relief and satisfactory results.