Advertisement

Posterior spinal cord injury due to dorsal migrated disc herniation caused by thoracolumbar fusion surgery: A case report

Published:October 11, 2022DOI:https://doi.org/10.1016/j.jos.2022.09.015
      Corrective fusion for adult spinal deformity has become popular recently. Although new techniques and devices have been developed for this procedure, adjacent segmental disease (ASD) can occur postoperatively, which can create severe complication for patients. Here, we describe an unusual case of thoracic ASD with induced spinal cord injury due to the dorsal migration of the herniation after thoracolumbar long fusion. Thoracic disc herniation is uncommon, especially dorsal extradural herniation [
      • Partheni M.
      • Fratzoglou M.
      • Kalogeropoulou C.
      • Zabakis P.
      • Panagiotopoulos V.
      • Konstantinou D.
      Dorsal extradural thoracic disc fragment: a diagnostic challenge.
      ,
      • Hur J.W.
      • Kim J.S.
      • Seung J.H.
      Full-endoscopic interlaminar discectomy for the treatment of a dorsal migrated thoracic disc herniation: case report.
      ]. To the best of our knowledge, this is the first report of thoracic dorsal extradural herniation caused by ASD.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Partheni M.
        • Fratzoglou M.
        • Kalogeropoulou C.
        • Zabakis P.
        • Panagiotopoulos V.
        • Konstantinou D.
        Dorsal extradural thoracic disc fragment: a diagnostic challenge.
        J Spinal Disord Tech. 2005 Dec; 18: 544-546
        • Hur J.W.
        • Kim J.S.
        • Seung J.H.
        Full-endoscopic interlaminar discectomy for the treatment of a dorsal migrated thoracic disc herniation: case report.
        Medicine (Baltim). 2019 May; 98e15541
        • Pfirrmann C.W.
        • Metzdorf A.
        • Zanetti M.
        • Hodler J.
        • Boos N.
        Magnetic resonance classification of lumbar intervertebral disc degeneration.
        Spine (Phila Pa 1976). 2001 Sep 1; 26: 1873-1878
        • Mesregah M.K.
        • Repajic M.
        • Patel K.
        • Gardner C.
        • Roberts S.
        • Buser Z.
        • Wang J.
        Trends and patterns of thoracic intervertebral disc degeneration in symptomatic subjects: a magnetic resonance imaging analysis.
        Eur Spine J. 2021 Aug; 30: 2221-2230
        • Cheh G.
        • Bridwell K.H.
        • Lenke L.G.
        • Buchowski J.M.
        • Daubs M.D.
        • Kim Y.
        • Baldus C.
        Adjacent segment disease followinglumbar/thoracolumbar fusion with pedicle screw instrumentation: a minimum 5-year follow-up.
        Spine (Phila Pa 1976). 2007 Sep 15; 32: 2253-2257
        • Toyone T.
        • Ozawa T.
        • Inada K.
        • Shirahata T.
        • Shiboi R.
        • Watanabe A.
        • Matsuki K.
        • Hasue F.
        • Fujiyoshi T.
        • Aoki Y.
        • Inoue G.
        • Orita S.
        • Ohtori S.
        • Wada Y.
        • Tanaka T.
        • Takahashi K.
        Short-segment fixation without fusion for thoracolumbar burst fractures with neurological deficit can preserve thoracolumbar motion without resulting in post-traumatic disc degeneration: a 10-year follow-up study.
        Spine (Phila Pa 1976). 2013 Aug 1; 38: 1482-1490
        • Matsumoto T.
        • Okuda S.
        • Maeno T.
        • Yamashita T.
        • Yamasaki R.
        • Sugiura T.
        • Iwasaki M.
        Spinopelvic sagittal imbalance as a risk factor for adjacent-segment disease after single-segment posterior lumbar interbody fusion.
        J Neurosurg Spine. 2017 Apr; 26: 435-440
        • Liljenqvist U.R.
        • Link T.M.
        • Halm H.F.
        Morphometric analysis of thoracic and lumbar vertebrae in idiopathic scoliosis.
        Spine (Phila Pa 1976. 2000 May 15; 25: 1247-1253
        • Agarwal N.
        • Heary R.F.
        • Agarwal P.
        Adjacent-segment disease after thoracic pedicle screw fixation.
        J Neurosurg Spine. 2018 Mar; 28: 280-286
        • Throckmorton T.W.
        • Hilibrand A.S.
        • Mencio G.A.
        • Hodge A.
        • Spengler D.M.
        The impact of adjacent level disc degeneration on health status outcomes following lumbar fusion.
        Spine (Phila Pa 1976. 2003 Nov 15; 28: 2546-2550
        • Kim J.H.
        • Kim S.S.
        • Suk S.I.
        Incidence of proximal adjacent failure in adult lumbar deformity correction based on proximal fusion level.
        Asian Spine J. 2007 Jun; 1: 19-26
        • Kim Y.J.
        • Bridwell K.H.
        • Lenke L.G.
        • Rhim S.
        • Cheh G.
        Sagittal thoracic decompensation following long adult lumbar spinal instrumentation and fusion to L5 or S1: causes, prevalence, and risk factor analysis.
        Spine (Phila Pa 1976. 2006 Sep 15; 31: 2359-2366
        • Badra M.I.
        • Assaker R.
        • Musharrafieh R.S.
        Acute paraplegia secondary to thoracic disc herniation of the adjacent segment following thoracolumbar fusion and instrumentation.
        Asian Spine J. 2013 Mar; 7: 55-59
        • Sasaki S.
        • Kaji K.
        • Shiba K.
        Upper thoracic disc herniation followed by acutely progressing paraplegia.
        Spin Cord. 2005 Dec; 43: 741-745
        • Aizawa T.
        • Sato T.
        • Sasaki H.
        • Matsumoto F.
        • Morozumi N.
        • Kusakabe T.
        • Itoi E.
        • Kokubun S.
        Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients.
        J Neurosurg Spine. 2007 Jul; 7: 13-20
        • Bose B.
        Thoracic extruded disc mimicking spinal cord tumor.
        Spine J. 2003 Jan-Feb; 3: 82-86
        • Tamburrelli F.C.
        • Perna A.
        • Oliva M.S.
        • Giannelli I.
        • Genitiempo M.
        Unusual posterior epidural migration of intervertebral herniated disc: a report of two cases.
        Malays Orthop J. 2018 Nov; 12: 47-49
        • Kim K.Y.
        • Kim Y.T.
        • Lee C.S.
        • Kang J.S.
        • Kim Y.J.
        Magnetic resonance imaging in the evaluation of the lumbar herniated intervertebral disc.
        Int Orthop. 1993 Aug; 17: 241-244
        • Komori H.
        • Okawa A.
        • Haro H.
        • Muneta T.
        • Yamamoto H.
        • Shinomiya K.
        Contrast-enhanced magnetic resonance imaging in conservative management of lumbar disc herniation.
        Spine (Phila Pa 1976). 1998 Jan 1; 23: 67-73
      1. Eerens I, Demaerel P, Haven F, van Loon J, Van Calenbergh F, Wilms G. Imaging characteristics of noncontained migrating disc fragment and cyst. Eur Radiol2001;11(5):854-857.

        • Ogawa T.
        • Kikuchi T.
        • Ikeuchi S.
        • Sanada S.
        • Nakajima T.
        • Anno I.
        [CT findings in acute spinal epidural hematoma caused by a ruptured cavernous angioma].
        No Shinkei Geka. 1986 Apr; 14: 687-691
        • Lakshmanan P.
        • Ahuja S.
        • Lyons K.
        • Howes J.
        • Davies P.R.
        Sequestrated lumbar intervertebral disc in the posterior epidural space: a report on two cases and review of the literature.
        Spine J. 2006 Sep-Oct; 6: 583-586
        • Dosoglu M.
        • Is M.
        • Gezen F.
        • Ziyal M.I.
        Posterior epidural migration of a lumbar disc fragment causing cauda equina syndrome: case report and review of the relevant literature.
        Eur Spine J. 2001 Aug; 10: 348-351
        • Shufflebarger H.
        • Suk S.I.
        • Mardjetko S.
        Debate: determining the upper instrumented vertebra in the management of adult degenerative scoliosis: stopping at T10 versus L1.
        Spine (Phila Pa 1976). 2006 Sep 1; 31: S185-S194