Three-level thoracic disc herniation: case report and review of the literature

A rare case of three-level thoracic disc herniation with associated neurological impairment, including motor, sensor and urinary disturbances, is reported. The diagnosis and localization of the level of cord compression were mainly based on the clinical examination supported by the findings of magnetic resonance imaging and somatosensory evoked potentials. An anterolateral transthoracic approach at the upper-most affected level was selected for removal of all herniated discs, with the use of a surgical microscope; the resected rib was used for intervertebral fusion. An improvement in the patient's subjective and neurological condition was already apparent a few months after the operation, and solid fusion was roentgenographically found at all operated levels. The use of a surgical microscope allows complete removal of the herniated disc while avoiding wide vertebrectomy and associated iatrogenic damage to the spinal cord.