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  • Title: Acute noncontiguous multiple-level thoracic disc herniations with myelopathy: a case report.
    Author: Chen CF, Chang MC, Liu CL, Chen TH.
    Journal: Spine (Phila Pa 1976); 2004 Apr 15; 29(8):E157-60. PubMed ID: 15083003.
    Abstract:
    STUDY DESIGN: The case report of a 38-year-old man with a unique acute, triple-level, noncontiguous thoracic disc herniation (T6, T9-T10, and T11-T12), delayed onset of lower limb weakness, paresthesias below the T10 dermatome, and urinary dysfunction following minor trauma resulting from a motorcycle accident. OBJECTIVES: To present an unusual case of herniation that could involve ambiguous test results (imaging findings not necessarily correlated with severity of clinical manifestations). SUMMARY OF BACKGROUND DATA: Multiple-level symptomatic disc herniations of the thoracic spine are rare, and the reported cases are mostly of contiguous, two-level lesions with chronic clinical presentation. No case of acute three-level noncontiguous ruptured thoracic disc herniations with myelopathy has been reported. METHODS: Through the left transthoracic approach, partial corpectomy, complete discectomy, and interbody fusion of the T9-T10 vertebrae were performed. The less prominent lesions of the T6 and T12-L1 vertebrae were left untreated. RESULTS: Remarkable improvement of neurologic symptoms, including motor weakness and bladder dysfunction, was observed 1 week after operation. At 1-year follow-up, he could walk without aid and with a somewhat spastic gait. However, paresthesias below dermatome T12 persisted. The patient refused to accept the recommendation of further surgical decompression of the nerves at the T6 and T12-L1 vertebral lesions. CONCLUSION: Since the presentation of thoracic disc herniation is variable and difficult to correlate with imaging findings, decompression at all lesion levels in a patient with symptomatic multiple-level ruptured thoracic disc herniations may be necessary to achieve complete symptom relief and satisfactory results.
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