2-LEVEL THORACIC DISC HERNIATION

Study Design. A double, contiguous disc herniation in the thoracic spi ne (T7-T8, T8-T9) in a 44-year-old man is reported. The patient compla ined of intermittent episodes of weakness and numbness in the lower ex tremities, paraesthesias radiating to the anterior and medial surfaces of the thigh and the leg (mostly on the left side), and mild sexual a nd urinary dysfunction. Objective. The treatment must achieve complete spinal cord decompression, prevent further herniation, and prevent ia trogenic vascular damage to the cord. A transthoracic approach seems t o offer the largest surgical view. Summary of Background Data. Twenty- six other cases of two-level thoractic disc herniation were found in t he literature, only five of which were treated with a transthoracic ap proach. Methods. Treatment consisted of complete disc excision (T7-T8 and T8-T9) with a right anterior transthoracic approach. Complete and safe removal of the discs required hemicorporectomy of T8 and subseque nt grafting and plating. Spinal cord angiography, showing the Adamkiew icz artery originating from the left T10, was performed before surgery . Computed tomography-guided methylene blue injection in the retropleu ral interspace of T7-T8 was done for intraoperative level localization . Results. At 1 year follow-up, complete relief of neurologic symptoms was observed, as was solid interbody fusion. Conclusion. In this case , a transthoracic approach was safe and effective for disc excision an d cord decompression via hemicorporectomy.