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|Year : 2022 | Volume
| Issue : 4 | Page : 1742-1743
Resolution of Thoracic Syringomyelia following Treatment of Thoracic Disc Herniation
Mohit Patel, Manish K Kasliwal
Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
|Date of Submission||10-Nov-2021|
|Date of Decision||22-Nov-2021|
|Date of Acceptance||27-Nov-2021|
|Date of Web Publication||30-Aug-2022|
Manish K Kasliwal
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH - 44106
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Patel M, Kasliwal MK. Resolution of Thoracic Syringomyelia following Treatment of Thoracic Disc Herniation. Neurol India 2022;70:1742-3
Thoracic disc herniation accounts for less than 1% of all spinal disc herniation cases. Patients can be asymptomatic or present with varied symptoms including localized pain, motor impairment in lower extremities, gait imbalance, and bowel or bladder dysfunction. Symptomatic thoracic disc herniation often leads to progressive motor deficits from spinal cord compression. Rarely, patients present with syringomyelia above the level of spinal cord compression. Herein, we describe a case of thoracic spinal cord syrinx with its resolution after successful treatment of the thoracic disc herniation.
The patient is a 46-year-old female who presented with two years of progressive gait imbalance and weakness in her lower extremities. On magnetic resonance imaging (MRI) of the thoracic spine, there was the presence of a thoracic disc herniation at T9-T10 and T10-T11 with syrinx at the levels above likely due to severe spinal cord compression at the herniated levels [Figure 1]a, [Figure 1]b, [Figure 1]c. Due to the presence of severe spinal cord compression, surgical decompression was performed via right-sided T9-T10 facetectomy and right T10 transpedicular decompression with T8-T11 instrumentation and fusion with circumferential spinal cord decompression at all levels of extradural spinal cord compression. The postoperative stay was uncomplicated with a stable neurological examination after surgery. At a 3-year follow-up, the patient had residual gait imbalance and an MRI of the thoracic spine obtained to rule out a progression of the thoracic syrinx showed no compression and resolution of the prior syrinx, and no further intervention was necessary [Figure 2]a and [Figure 2]b.
|Figure 1: Preoperative T2W sagittal and axial MRI showing spinal cord compression at the level of T9-T10 (1a) and T10-T11 level (1b) with a T2W MRI showing thoracic syrinx above the disc herniation (1c)|
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|Figure 2: Postoperative T2W sagittal and axial MRI at the level of T9-T10 (2a) and T10-11 (2b) with no visualized thoracic syrinx following surgery|
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This case highlights a rare case of syringomyelia from a thoracic disc herniation and further supports the finding that the development of spinal cord syrinx is often related to alteration of cerebrospinal fluid dynamics from extra-axial pathologies, either intradurally or extradurally that cause spinal cord compression., This case provides objective evidence of the resolution of syrinx after treatment of thoracic disc herniation, and surgeons should refrain from direct intervention for intramedullary syringomyelia until all extradural spinal compressive pathologies have been completely addressed.
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Conflicts of interest
There are no conflicts of interest.
| » References|| |
Kasliwal MK, Deutsch H. Minimally invasive retropleural approach for central thoracic disc herniation. Minim Invasive Neurosurg 2011;54:167-71.
El Ouadih Y, Coll G, Haro Y, Chaix R. Resolution of isolated syringomyelia after removing thoracic disc herniation. Br J Neurosurg 2020;34:196-9.
Yaman ME, Eylen A, Ayberk G. Resolution of isolated syringomyelia after treatment of cervical disc herniation: Association or coincidence? Bratisl Lek Listy 2012;113:500-2.
[Figure 1], [Figure 2]