Two brothers with a symptomatic thoracic disc herniation at T11–T12: clinical report

Overvliet, Geke M.; Beuls, E. A. M.; Laak-Poort, Mariel ter; Cornips, Erwin M. J.

doi:10.1007/s00701-009-0244-2

Cited by 14 publications

(4 citation statements)

References 19 publications

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“…In the adult population, the incidence of symptomatic TDHs has been estimated at 1/1.000.000 [10] [12] [15] but may actually be higher considering a prevalence of 37% on MR imaging in asymptomatic individuals [20]. The incidence of symptomatic TLJDHs is essentially unknown as these have rarely been analyzed as a separate clinical entity [ to 83 years, and involved level from T2-T3 to T12-L1, including 35 (9.8%) TMDs at T10-T11, 52 (14.2%) at T11-T12, and 9 (2.5%) at T12-L1.…”

Section: Incidence and Clinical Presentation Of Tljdhsmentioning

confidence: 99%

“…In the pediatric population, there are merely case reports of symptomatic TDHs [6] [16]- [18], including one 16-year-old girl with a T10-T11 disc herniation at the upper limit of the TLJ [8]. These TDHs (especially when calcified and/or associated with Scheuermann's disease) may be related to a growth disturbance rather than to disc degeneration [12] [23]. They may be underdiagnosed because they are not included in the differential diag-nosis.…”

Section: Incidence and Clinical Presentation Of Tljdhsmentioning

confidence: 99%

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Thoraco-Lumbar Junction Disc Herniation and Tight Filum: A Unique Combination?

Cornips¹,

Beuls²,

Weber³

et al. 2014

IJCM

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Purpose: The incidence of both symptomatic thoraco-lumbar junction disc herniation (TLJDH) and tight filum (TF) may be underestimated. Both conditions have a complex clinical presentation that may involve the distal spinal cord, conus medullaris, and/or cauda equina, including upper and/or lower motor neuron impairment, sensory impairment, urological and sexual dysfunction. The coexistence of both conditions has not been previously reported and may be a diagnostic and therapeutic challenge. Methods: We report three teenage girls, a 24-year-old woman, and two middleaged women who were diagnosed with both conditions and treated at our institution. Results: Disc herniation level was T11-T12 in 2, T12-L1 in 3, and L1-L2 in one. All patients had a fatty filum (n = 5) and/or a low-lying CM (at or above L1-L2 in 2, at or below L2-L3 in 4), and were treated with filum sectioning first. All patients noted marked improvement of preoperative complaints including back pain (n = 5), leg pain and fatigue (n = 4), urological complaints (n = 4), and toe gait (n = 1). One 16-year-old girl successfully underwent a thoracoscopic microdiscectomy for persisting pain at the thoraco-lumbar junction two years after filum sectioning. Conclusions: Thoraco-lumbar junction disc herniation and tight filum both act on the distal spinal cord close to the transition to the cauda equina. Both conditions may coincide and may even act synergistically, the disc herniation acting as a fulcrum, aggravating the deleterious effect of the tethering force (and vice versa). This might explain why both conditions combined may present at a younger age. We suggest filum sectioning as the primary treatment option in all patients, however, more cases and a longer follow-up are needed to better understand their unique combination and interaction. Nevertheless, when confronted with a symptomatic TLJDH especially in young patients we advise to rule out a coinciding TF by careful consideration of all clinical, radiological, and urological data.

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Section: Incidence and Clinical Presentation Of Tljdhsmentioning

confidence: 99%

Section: Incidence and Clinical Presentation Of Tljdhsmentioning

confidence: 99%

Thoraco-Lumbar Junction Disc Herniation and Tight Filum: A Unique Combination?

Cornips¹,

Beuls²,

Weber³

et al. 2014

IJCM

Self Cite

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“…Variability in the size and form (shape 1 size) of the spinal canal, or neural foramen, and the vertebral body has been the subject of many clinical and paleopathological studies, as it has been associated with conditions such as acquired and developmental spinal stenosis, scoliosis, and spondylolysis (clinical literature: Inufusa et al, 1996;Harrington et al, 2001;Masharawi, 2008Masharawi, , 2012Meijer et al, 2010;Abbas et al, 2010;paleopathological literature: Clark et al, 1986;Watts, 2010). Schmorl's nodes are a relatively common spinal pathology in both clinical and archaeological contexts (clinical literature: Dar et al, 2009;Overvliet et al, 2009;Jang et al, 2010;paleopathological literature: Š laus, 2000;Ü stü ndag , 2009;Klaus et al, 2009). Clinically, herniation of the intervertebral disc shows little correlation with a patient's age, but discs with adjacent Schmorl's nodes can display degenerative changes earlier than those without (Adams et al, 2000).…”

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confidence: 99%

Vertebral morphology influences the development of Schmorl's nodes in the lower thoracic vertebrae

Plomp

Roberts

Viðarsdóttir

2012

American J Phys Anthropol

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Schmorl's nodes are the result of herniations of the nucleus pulposus into the adjacent vertebral body and are commonly identified in both clinical and archaeological contexts. The current study aims to identify aspects of vertebral shape that correlate with Schmorl's nodes. Two-dimensional statistical shape analysis was performed on digital images of the lower thoracic spine (T10-T12) of adult skeletons from the late medieval skeletal assemblages from Fishergate House, York, St. Mary Graces and East Smithfield Black Death cemeteries, London, and postmedieval Chelsea Old Church, London. Schmorl's nodes were scored on the basis of their location, depth, and size. Results indicate that there is a correlation between the shape of the posterior margin of the vertebral body and pedicles and the presence of Schmorl's nodes in the lower thoracic spine. The size of the vertebral body in males was also found to correlate with the lesions. Vertebral shape differences associated with the macroscopic characteristics of Schmorl's nodes, indicating severity of the lesion, were also analyzed. The shape of the pedicles and the posterior margin of the vertebral body, along with a larger vertebral body size in males, have a strong association with both the presence and severity of Schmorl's nodes. This suggests that shape and/or size of these vertebral components are predisposing to, or resulting in, vertically directed disc herniation.

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“…While TDHs are most commonly present in the setting of trauma (either external trauma or microtrauma in the setting of physiological movement making up 49% of all causes of TDHs [ 3 ]), a subset of TDHs can be seen with other associated conditions such as Scheuermann’s disease in the pediatric population, hereditary connective tissue disorders such as Ehlers-Danlos syndromes or Marfan syndrome, smoking, congenital stenosis, obesity, and those with sedentary lifestyles [ 4 ]. Rarely, spontaneous cases have been reported such as a case where two brothers aged 32 and 34 both had TDHs with no other predetermined risk factors suggesting an underlying genetic predisposition [ 4 ]. Our patient had no inciting trauma, but tobacco and underlying congenital stenosis were identiﬁed as risk factors that likely contributed to disc degeneration and acute presentation.…”

Section: Discussionmentioning

confidence: 99%

Non-traumatic Spontaneous Paraplegia Secondary to Thoracic Disc Herniations in the Setting of Tobacco Abuse and COVID-19: A Case Report and Literature Review

Whitney¹,

Kiessling²,

Hamann³

et al. 2022

Cureus

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Two brothers with a symptomatic thoracic disc herniation at T11–T12: clinical report

Abstract: Background In contrast to what is commonly believed, thoracic disc herniations are not rare lesions.

Cited by 14 publications

References 19 publications

Thoraco-Lumbar Junction Disc Herniation and Tight Filum: A Unique Combination?

Thoraco-Lumbar Junction Disc Herniation and Tight Filum: A Unique Combination?

Vertebral morphology influences the development of Schmorl's nodes in the lower thoracic vertebrae

Non-traumatic Spontaneous Paraplegia Secondary to Thoracic Disc Herniations in the Setting of Tobacco Abuse and COVID-19: A Case Report and Literature Review

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