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Paper title A case of intradural thoracic disc herniation: technical report
Paper code P45
Authors
  1. Ramona Guatta Cantonal Hospital Lugano Speaker
  2. Adrien Thomas May HFR Fribourg, Hôpital Cantonal, University of Fribourg, Switzerland
  3. Karl Schaller HUG Hôpitaux Universitaires Genève
  4. Enrico Tessitore Geneva University Hospitals (HUG)
Form of presentation Poster
Topics
  • Joint SSNR | SSNS
Abstract text Objective

The aim of this report is to describe the rare case of a thoracic intradural disc herniation with provided detailed video and imaging illustrations of the surgical procedure.

Background

Intradural disc herniations (IDH) are rare, comprising from 0.2% to 2.2% of all herniated discs (1). The most frequent localization is the lumbar region (92%), followed by the thoracic (5%) and lastly the cervical one (3%) (2). The radiologic preoperative diagnosis of the intradural component by MRI or CT scan myelogram is difficult and it is therefore often identified intraoperatively. Here, we describe a case of intradural thoracic disc herniation.

Case report

We report on the case of a 49-year-old female, who had undergone elsewhere to incomplete removal of two thoracic disc herniations at Th7-Th8 and Th8-Th9 levels. At a 8-month follow-up, the patient complained of persistent left thoracic pain, mild to severe paraparesis with normal bladder and bowel function. The MRI revealed persistence of a calcified median and paramedian Th8-Th9 disc herniation with compression and displacement of the thoracic cord. Patient was operated on through a left side thoracotomy under neuromonitoring. During surgery, the calcified disc was dissected and drilled away from the dura mater. An intradural component was identified and resected. The CSF leakage was managed by combined local application of Tachosil and Tisseel . Patient was left 2 days at bed, then early mobilization have started. Immediate relief of the thoracic and leg pain was reported after the operation, and the patient was sent to rehabilitation center.

Conclusion

In conclusion, establishing the diagnosis of IDH prior to surgery is difficult, especially in patients with previous interventions at the same level. Physicians should be aware of this rare type of disc herniation in order to provide the best therapeutic approach.