Sleep apnea and unilateral upper and lower extremity allodynia as a result of a large thoracic disc herniation: a case report

Abstract Background Clinically significant disc herniations in the thoracic spine are rare accounting for approximately 1% of all disc herniations. In patients with significant spinal cord compression, presenting symptoms typically include ambulatory dysfunction, lower extremity weakness, lower extremity sensory changes, as well as bowl, bladder, or sexual dysfunction. Thoracic disc herniations can also present with thoracic radiculopathy including midback pain and radiating pain wrapping around the chest or abdomen. The association between thoracic disc herniation with cord compression and sleep apnea is not well described. Case presentation The following is a case of a young male patient with high grade spinal cord compression at T7-8, as a result of a large thoracic disc herniation. The patient presented with complaints of upper and lower extremity unilateral allodynia and sleep apnea. Diagnosis was only made once the patient manifested more common symptoms of thoracic stenosis including left lower extremity weakness and sexual dysfunction. Following decompression and fusion the patient’s allodynia and sleep apnea quickly resolved. Conclusions Thoracic disc herniations can present atypically with sleep apnea. We recommend taking into consideration that sleep symptoms may resolve when planning treatment for thoracic disc herniation.

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Sleep Apnea and Unilateral Upper and Lower Extremity Allodynia as a Result of a Large Thoracic Disc Herniation: A Case Report

10.21203/rs.3.rs-233683/v1 ◽

2021 ◽

Author(s):

Tyler D. Alexander ◽

Anthony Stefanelli ◽

Sara Thalheimer ◽

Joshua E. Heller

Keyword(s):

Spinal Cord ◽

Sleep Apnea ◽

Sexual Dysfunction ◽

Lower Extremity ◽

Disc Herniation ◽

Cord Compression ◽

Thoracic Disc Herniation ◽

Lower Extremity Weakness ◽

Disc Herniations ◽

Thoracic Disc

Abstract BackgroundClinically significant disc herniations in the thoracic spine are rare accounting for approximately 1% of all disc herniations. In patients with significant spinal cord compression, presenting symptoms typically include ambulatory dysfunction, lower extremity weakness, lower extremity sensory changes, as well as bowl, bladder, or sexual dysfunction. Thoracic disc herniations can also present with thoracic radiculopathy including midback pain and radiating pain wrapping around the chest or abdomen. The association between thoracic disc herniation with cord compression and sleep apnea is not well described.Case PresentationThe following is a case of a young male patient with high grade spinal cord compression at T7-8, as a result of a large thoracic disc herniation. The patient presented with complaints of upper and lower extremity unilateral allodynia and sleep apnea. Diagnosis was only made once the patient manifested more common symptoms of thoracic stenosis including left lower extremity weakness and sexual dysfunction. Following decompression and fusion the patient’s allodynia and sleep apnea quickly resolved.ConclusionsThoracic disc herniations can present atypically with sleep apnea – a symptom which may resolve with surgical treatment.

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Transdural Spinal Cord Herniation: An Exceptional Complication of Thoracoscopic Discectomy: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab058 ◽

2021 ◽

Author(s):

Benjamin Pommier ◽

Michaël Grelat ◽

Rostom Messerer ◽

Sylvain Portet ◽

Cédric Y Barrey

Keyword(s):

Spinal Cord ◽

Lower Extremity ◽

Disc Herniation ◽

Posterolateral Approach ◽

Thoracic Disc Herniation ◽

Lower Extremity Weakness ◽

Initial Surgery ◽

Spinal Cord Herniation ◽

Dural Tears ◽

Thoracic Disc

Abstract Thoracic disc herniation is a rare and severe condition, whose treatment may have complications including dural tears. Although benign in most cases, dural tears may induce iatrogenic transdural herniation of the spinal cord. The video demonstrates the diagnosis and surgical treatment of iatrogenic transdural herniation of the spinal cord. Here, we report a case of spinal cord herniation after thorascopic treatment of a thoracic disc herniation (DH). A 28-yr-old male presented with several years of left lower extremity weakness and was found to have a T6-7 DH. He underwent DH resection through video assisted mini-thoracotomy at another institution. In the immediate postoperative period, he developed a Brown-Sequard syndrome with left leg weakness. The surgeon decided not to reoperate and the patient improved with rehabilitation, allowing him to walk again. At 6 mo postop, he experienced sudden neurologic worsening but did not present to our clinic until 6 mo later. At this time, he had near complete paraplegia with bilateral lower extremity spasticity and central neuropathic pain. MRI showed a pseudo-meningocele and features suggesting a lateral spinal cord herniation. After a multidisciplinary meeting, we elected to perform a posterolateral approach with costo-arthro-pediculectomy and durotomy to repair the SC herniation. Immediately postop, the patient had a slight improvement in right lower extremity function, with decreased pain and spasticity. This case shows a transdural SC herniation, a rare complication after resection of DH. It is possible that an unreported or unrecognized dural tear at the time of the initial surgery, combined with the negative pressure of the thoracic cavity, put the patient at risk for this particular complication. The authors state that the patient gave his informed consent.

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Revision surgery in thoracic disc herniation

European Spine Journal ◽

10.1007/s00586-019-06212-w ◽

2019 ◽

Vol 29 (S1) ◽

pp. 39-46

Author(s):

Stephan Dützmann ◽

Roli Rose ◽

Daniel Rosenthal

Keyword(s):

Disc Herniation ◽

Revision Surgery ◽

Cord Compression ◽

Thoracic Disc Herniation ◽

Disc Disease ◽

Neurological Improvement ◽

Initial Symptoms ◽

Disc Herniations ◽

Clinical Records ◽

Thoracic Disc

Abstract Purpose Surgical treatment failures or strategies for the reoperation of residual thoracic disc herniations are sparsely discussed. We investigated factors that led to incomplete disc removal and recommend reoperation strategies. Methods As a referral centre for thoracic disc disease, we reviewed retrospectively the clinical records and imaging studies before and after the treatment of patients who were sent to us for revision surgery for thoracic disc herniation from 2013 to 2018. Results A total of 456 patients were treated from 2013 to 2018 at our institution. Twenty-one patients had undergone previously thoracic discectomy at an outside facility and harboured residual, incompletely excised and symptomatic herniated thoracic discs. In 12 patients (57%), the initial symptoms that led to their primary operation were improved after the first surgery, but recurred after a mean of 2.8 years. In seven patients (33%) they remained stable, and in two cases they were worse. All patients were treated via all dorsal approaches. In all 21 cases, the initial excision was incomplete regarding medullar decompression. All of the discs were removed completely in a single revision procedure. After mean follow-up of 24 months (range 12–57 months), clinical neurological improvement was demonstrated in seven patients, while three patients suffered a worsening and 11 patients remained stable. Conclusion Our data suggest that pure dorsal decompression provides a short relief of the symptoms caused by spinal cord compression. Progressive myelopathy (probably due to mechanical and vascular deficits) and scar formation may cause worsening of symptoms. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

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Transthoracic Discectomy for Symptomatic Thoracic Disc Herniation: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy407 ◽

2019 ◽

Vol 17 (4) ◽

pp. E158-E158

Author(s):

Yamaan S Saadeh ◽

Siri S Khalsa ◽

Brandon W Smith ◽

Jacob R Joseph ◽

Rhami F Khorfan ◽

...

Keyword(s):

Spinal Cord ◽

Back Pain ◽

Disc Herniation ◽

Interbody Fusion ◽

Cord Compression ◽

Lower Extremity Muscle ◽

High Clinical Suspicion ◽

Disc Herniations ◽

Thoracic Disc

Abstract Thoracic disc herniations are an infrequent occurrence, but can be a cause of significant myelopathy. Diagnosis typically requires a high clinical suspicion that is confirmed with appropriate imaging. Classically, the transthoracic approach for discectomy is the treatment of choice for symptomatic cases. This video concerns a 48-yr-old woman who presented with worsening mid-back pain and progressive gait difficulty. Her examination was significant for proximal lower extremity muscle weakness, difficulty with tandem gait, and urinary incontinence. Imaging demonstrated a large T7-8 disc herniation causing severe spinal cord compression. The patient underwent T7-8 transthoracic discectomy and interbody fusion. She tolerated the procedure well without complication, and postoperative imaging demonstrated decompression of her spinal cord. On follow-up, she had improved mid-back pain, strength, and ambulatory function. The patient consented to the recording of this surgical video for potential publication.

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Spinal Cord Compression Due to Thoracic Disc Herniation: Results of Microsurgical Posterolateral Costotransversectomy

British Journal of Neurosurgery ◽

10.3109/02688698909001023 ◽

1989 ◽

Vol 3 (1) ◽

pp. 31-38 ◽

Cited By ~ 11

Author(s):

Steven Young ◽

George Karr ◽

Sean A. O'laoire

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Disc Herniation ◽

Cord Compression ◽

Thoracic Disc Herniation ◽

Thoracic Disc

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Thoracic intramedullary neurosarcoidosis with thoracic disc herniation: Diagnostic importance of intramedullary contrast enhancement

Surgical Neurology International ◽

10.25259/sni_535_2021 ◽

2021 ◽

Vol 12 ◽

pp. 331

Author(s):

Justin Beiriger ◽

Hussam Abou-Al-Shaar ◽

Hansen Deng ◽

Mansour Mathkour ◽

David O. Okonkwo

Keyword(s):

Spinal Cord ◽

Contrast Enhancement ◽

Disc Herniation ◽

Mediastinal Lymphadenopathy ◽

Thoracic Disc Herniation ◽

Thoracic Spinal Cord ◽

Lower Extremity Weakness ◽

Radiographic Findings ◽

Signal Change ◽

Thoracic Disc

Background: Thoracic intramedullary neurosarcoidosis is an uncommon but serious manifestation of spinal cord disease. Its concomitant occurrence with thoracic disc herniation can mislead the physician into attributing neurologic and radiographic findings in the spinal cord to disc pathology rather than inflammatory disorder. Here, we present such a rare case of concomitant thoracic disc and spinal neurosarcoidosis. Case Description: A 37-year-old male presented with progressive right lower extremity weakness and numbness. Magnetic resonance imaging (MRI) of the thoracic spinal cord revealed a T6-T7 paracentral disc eccentric to the right with T2 signal change extending from T2 to T10 level. This prompted acquiring a contrasted MRI that also depicted intramedullary enhancement around the T6-T7 disc bulge. Computed tomography scan of the chest showed mediastinal lymphadenopathy concerning for sarcoidosis. Lymph node biopsy confirmed the diagnosis of sarcoidosis, and high-dose steroid treatment was initiated. The patient had significant symptomatic improvement with steroids with full neurological recovery and improvement of his symptoms. Conclusion: While stenosis from thoracic disc disease could potentially suggest a mechanical etiology for the patient’s symptoms, attention must be paid to the imaging findings as well as the degree and extent of cord signal change and intramedullary contrast enhancement. Appropriate and timely diagnosis is essential to avoid unnecessary invasive procedures.

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Operation of Soft or Calcified Thoracic Disc Herniations in the Full-Endoscopic Uniportal Extraforaminal Technique

January 2018 - Pain Physician ◽

10.36076/ppj.2018.4.e331 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E331-E340 ◽

Cited By ~ 7

Author(s):

Sebastian Ruetten

Keyword(s):

Spinal Cord ◽

Retrospective Study ◽

Minimally Invasive ◽

Disc Herniation ◽

Thoracic Spine ◽

Surgical Trauma ◽

Thoracic Disc Herniation ◽

Soft Or ◽

Disc Herniations ◽

Thoracic Disc

Background: Surgery for thoracic disc herniation and stenosis is comparatively rare and often demanding. The goal is to achieve sufficient decompression without manipulating the spinal cord and to minimize surgical trauma and its consequences. Individual planning and various surgical techniques and approaches are required. The key factors for selecting the technique are anatomical location, consistency of the pathology, general condition of the patient, and the surgeon’s experience. Objectives: The objective of the study was the evaluation of the technical implementation and outcomes of a full-endoscopic uniportal technique via the extraforaminal approach in patients with symptomatic soft or calcified disc herniation of the thoracic spine, taking specific advantages and disadvantages and literature into consideration. Study Design: Retrospective study Setting: A center for spine surgery and pain medicine. Methods: Between 2009 and 2015, decompression was performed on 26 patients with thoracic disc herniation or stenosis with radicular or myelopathic symptoms in a full-endoscopic uniportal technique with an extraforaminal approach. No patients underwent additional posterior stabilization. Imaging and clinical data were collected in follow-up examinations for 18 months. Results: Sufficient decompression was achieved in the full-endoscopic uniportal technique in all cases. The individual selection of the respective approach made it possible to reach the target area without manipulating the spinal cord. One patient experienced deterioration of a myelopathy. No other serious complications were observed. All patients, except one, experienced regression or improvement of symptoms. No evidence of increasing instability was found in imaging. Limitations: This is a retrospective study. The limited number of cases must be considered. Conclusions: The full-endoscopic uniportal technique with an extraforaminal approach was found to be a sufficient and minimally invasive method with the known advantages of an endoscopic procedure under continuous irrigation for monosegmental disc herniations. The inclusion criteria must be taken into consideration. If they are not met, an alternative full-endoscopic approach (interlaminar, transthoracic retropleural) or decompression in a conventional method must be selected. Additional stabilization does not appear to be necessary due to the low level of trauma. Key Words: Extraforaminal approach, thoracic disc herniation, giant disc herniation, Fullendoscopic, minimally invasive, thoracic spine

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Thoracic Disc Herniation Presenting with Transient Anterior Spinal Artery Syndrome

Interventional Neuroradiology ◽

10.1177/159101990000600408 ◽

2000 ◽

Vol 6 (4) ◽

pp. 327-331 ◽

Cited By ~ 12

Author(s):

J.D. Guest ◽

D.E. Griesdale ◽

T. Marotta

Keyword(s):

Spinal Cord ◽

Disc Herniation ◽

Sudden Onset ◽

Anterior Spinal Artery ◽

Thoracic Disc Herniation ◽

Anterior Spinal Artery Syndrome ◽

Disc Herniations ◽

Artery Of Adamkiewicz ◽

Severe Back Pain ◽

Thoracic Disc

This report is a clinical and radiologic correlation of anterior spinal arterial distribution ischemia with a thoracic disc herniation affecting the artery of Adamkiewicz. We could only find one other similar reported case. A 38-year-old woman developed sudden onset of severe back pain and radiculopathy, followed by rapidly evolving paraparesis. The neurological examination was consistent with a deficit caused by anterior spinal artery ischemia. MRI revealed T2 signal change in the thoracolumbar spinal cord and a laterally placed, non-calcified disc herniation. Selective spinal angiography performed 30 hours after onset revealed displacement of the left T9 radicular feeding artery by the disc herniation; at this time the artery was patent. The patient experienced some resolution of symptoms within the first 24 hours and was managed conservatively and made a significant recovery within two weeks. Appropriately located thoracic disc herniations can disturb the blood supply to the thoracolumbar spinal cord.

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A surgical approach through the pedicle to protruded thoracic discs

Journal of Neurosurgery ◽

10.3171/jns.1978.48.5.0768 ◽

1978 ◽

Vol 48 (5) ◽

pp. 768-772 ◽

Cited By ~ 176

Author(s):

Russel H. Patterson ◽

Ehud Arbit

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Disc Herniation ◽

Surgical Approach ◽

Cord Compression ◽

Thoracic Disc Herniation ◽

Midline Incision ◽

Content Type ◽

Thoracic Disc ◽

Fine Print

✓ Three cases of thoracic disc herniation presenting with signs of spinal cord compression are reported. The patients were operated on by an approach through a midline incision in which a pedicle is removed. Two patients were cured and one has improved.

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Multiple Thoracic Disc Herniations: Case Report

Neurosurgery ◽

10.1227/00006123-198806010-00016 ◽

1988 ◽

Vol 22 (6P1-P2) ◽

pp. 1068-1070 ◽

Cited By ~ 13

Author(s):

Jitsuhiko Shikata ◽

Takao Yamamuro ◽

Hirokazu Iida ◽

Naoya Kashiwagi

Keyword(s):

Spinal Cord ◽

Disc Herniation ◽

Cord Compression ◽

Autogenous Bone ◽

Intervertebral Disc Herniation ◽

Computed Tomographic ◽

Disc Herniations ◽

Thoracic Disc ◽

Herniated Discs ◽

Autogenous Bone Grafts

Abstract Multiple thoracic disc herniation is rare, and one of the main problems in its treatment has been the lack of accuracy in diagnostic tests. Now, with the advent of computed tomographic scanning with metrizamide in the subaraehnoid space, the accuracy has been greatly improved. With computed tomographic scanning, the type and level of the lesion can be demonstrated, even when the myelographic study is unclear. Our report describes the case of a 38-year-old man with multiple thoracic intervertebral disc herniation, who also exhibited symptoms of spinal cord compression. Computed tomographic metrizamide myelography clearly showed anterior compression of the spinal cord due to disc herniation at T5-T6, T6-T7, T7-T8, T8-T9, and T9-T10. Removal ofthe herniated discs was followed by interbody fusion using autogenous bone grafts, and excellent results were obtained.

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