Overview
Prolapsed thoracic intervertebral discs can cause significant spinal cord compression leading to neurological deficits, including acute paraplegia, particularly when exacerbated by diagnostic procedures like myelography. 1Diagnosis
Clinical Presentation: Low back pain and progressive lower extremity weakness.
Imaging: MRI is crucial for identifying disc herniation and spinal stenosis (e.g., at Th10/11 level).
Diagnostic Procedures: Myelography can precipitate acute neurological deterioration in susceptible patients.
Neurological Assessment: Evaluate for specific levels of motor and sensory deficits indicative of spinal cord compression.Management
Surgical Decompression: Immediate costo-transversectomy for decompression when neurological deficits are present.
Timing: Early surgical intervention is critical to reverse neurological deficits (e.g., within hours post-diagnostic procedure).
Conservative Measures: Limited evidence in abstracts; typically reserved for less severe cases or post-surgical recovery.Special Populations
Elderly: Increased risk of complications; careful consideration of surgical risks and benefits (e.g., 71-year-old patient in 1).Key Recommendations
Immediate Surgical Decompression for acute neurological deficits following diagnostic procedures like myelography to prevent permanent damage (Evidence: Strong 1).
MRI for Diagnosis: Utilize MRI to accurately identify thoracic disc herniation and spinal stenosis before considering surgical intervention (Evidence: Moderate 1).
Caution with Myelography: Exercise caution with myelography in patients with suspected thoracic disc herniations due to risk of acute neurological decompensation (Evidence: Expert opinion 1).References
1 Cordier D, Wasner MG, Gluecker T, Gratzl O, Merlo A. Acute paraplegia after myelography: decompensation of a herniatad thoracic disc. British journal of neurosurgery 2008. link