T9-T10 and T10-T11 Thoracic Disc Herniation in 50 Year Old Man Causing Paraparesis

Transpedicular Thoracic Disc Resection

•50 year old man who underwent multiple lumbar laminectomy elsewhere without improvement with persistent paraparesis in wheelchair unable to walk

•Further workup with thoracic spine studies showed large thoracic disc herniation at T10 T11 and T9 T10 causing severe spinal cord pressure

Note prior lumbar laminectomy

Preop Thoracic MRI scan lateral

Preop MRI axial

Preop CT showing some calcifications

Postop X rays

Postop CT cuts

Surgery

•Transpedicular corpectomy T9 to T11 with T10 T11 partial pedical resection and resection of the calcified disc fragments

•T9 T12 laminectomy

•T9 T12 posterolateral fusion with iliac crest bone grafting

•6 hour surgery with 1200cc blood loss

•Marked improvement in MEP and SSEP spinal cord signals as the surgery progressed

Final Outcome

•Patient is back to normal neurologically out of wheel chair

•Release to work to his self employment

•Highly gratifying surgery