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CURRENT ISSUECHIRURGIA

A Journal on Surgery


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CASE REPORTS  


Chirurgia 2016 August;29(4):140-2

language: English

Thoracic “soft” disk herniation producing sudden paraplegia in an adult patient

Rodolfo MADURI 1, Daniele STARNONI 1, Lukas BOBINSKI 1, 2, John M. DUFF 1, 3

1 Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland; 2 Spine Unit, Department of Orthopedic Surgery, University Hospital of Uppsala, Uppsala, Sweden; 3 Faculty of Biology and Medicine, Lausanne, Switzerland


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Sudden paraplegia due to thoracic disk herniation without any previous symptoms has been episodically described in adult patients and surgical outcome is generally good. This report describes a case of thoracic “soft” disc herniation with acute flaccid paraplegia in an adult patient. A 58-year-old male presented with acute spontaneous paraparesis leading to paraplegia with sensory level at T12. Voluntary anal contraction was absent (Nurick Grade V). There was no history of preceding trauma. Thoraco-lumbar MRI showed a large T10-T11 left paracentral disc herniation compressing the spinal cord. The patient underwent emergency surgical decompression. There was no clinical improvement in the immediate postoperative period. After twelve months of follow up, the patient presented slight improvement of muscle strength in the right leg (Nurick Grade IV). There was no recovery of voluntary anal sphincter contraction. TDH accounts for less than 1% of symptomatic spinal disc herniation. Approximately 4% of “hard” consistency TDH presents with acute myelopathy mostly in pediatric patients. Here, we report a rare case of sudden onset flaccid paraplegia due to soft T10-T11 centrolateral disc herniation without improvement of neurologic conditions despite urgent decompressive surgery.

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