[Lower thoracic disc herniation with acutely developed vesicorectal dysfunction: case report]

Area of Science:

• Neurosurgery
• Spinal Surgery
• Neurology

Background:

• Thoracic disc herniation is a rare condition, typically slow-progressing and occurring in the lower thoracic spine.
• Acute presentation of thoracic disc herniation with severe neurological deficits is uncommon.

Observation:

• A 45-year-old woman presented with acute severe back pain, followed by vesicorectal dysfunction (urinary difficulty and fecal incontinence).
• Neurological examination revealed sensory loss below S1, a hypotonic bladder, absent anal reflex, and lower extremity weakness.
• Initial MRI suggested lumbar disc herniation, but myelography and CT myelography confirmed a centrolateral disc herniation at Th 11-12 compressing the spinal cord.

Findings:

• Surgical removal of the Th 11-12 disc herniation was performed using a transpedicular approach combined with transversectomy.
• The procedure successfully decompressed the spinal cord without causing further neurological damage.
• Postoperatively, the patient's vesicorectal dysfunction resolved immediately.

Implications:

• This case highlights that thoracic disc herniation can present acutely with significant neurological deficits, including vesicorectal dysfunction.
• The transpedicular approach with transversectomy is an effective surgical strategy for managing centrolateral thoracic disc herniations.
• Early surgical intervention can lead to rapid recovery of neurological function, even in cases with severe initial symptoms.