초록접수 미리보기
| 22KS-002 |
Two case reports of unusual presentations of thoracic disc herniation treated by thoracic epidural block
Department of Anesthesiology and Pain Medicine,
Medical School, Jeonbuk National University
Introduction
Herniation of the thoracic intervertebral disc (HTD) is a rare disease that accounts for less than 1% of all disc herniations. Physicians may make a diagnostic error due to the variable clinical features and limited experience of HTD. We present two unusual cases of HTD in this case report.
case
A 72-year-old woman (case 1) visited our pain clinic for chronic abdominal discomfort with visible bulging on the left side. Atrophy of the abdominal wall muscle and quadratus lumborum was observed. The therapeutic effect of interfascial plane block to exclude the possibility of truncal neuropathy following muscular atrophy was temporary. The patient underwent whole-spine magnetic resonance imaging (MRI) for further evaluation. Based on the evaluation, she was diagnosed with multiple HTD at T8/9/10/11 without myelopathy (Figure 1).
The other patient, a 75-year-old man (case 2) complained of aggravation of a previously diagnosed postherpetic neuralgia. Extension of the previously symptomatic area forward upper dermatome was observed. Conservative treatment including radiofrequency treatment on the symptomatic dorsal root ganglion failed to relieve the symptoms. On T-spine MRI, a foraminal herniated disc at the left T9/10 level with a mild degree of disc protrusion at T8/9/10 was identified (Figure 2), which was compatible with his current symptoms. Both patient were successfully treated with transforaminal epidural block.
Conclusion
Multi-level HTD of the mid- to lower- thoracic spine may present as abdominal bulging with atrophy of the abdominal wall muscles. Concomitant PHN and HTD at adjacent thoracic levels may also occur. Thoracic transforaminal epidural blocks should be considered as a conservative therapeutic approach for HTD.
Herniation of the thoracic intervertebral disc (HTD) is a rare disease that accounts for less than 1% of all disc herniations. Physicians may make a diagnostic error due to the variable clinical features and limited experience of HTD. We present two unusual cases of HTD in this case report.
case
A 72-year-old woman (case 1) visited our pain clinic for chronic abdominal discomfort with visible bulging on the left side. Atrophy of the abdominal wall muscle and quadratus lumborum was observed. The therapeutic effect of interfascial plane block to exclude the possibility of truncal neuropathy following muscular atrophy was temporary. The patient underwent whole-spine magnetic resonance imaging (MRI) for further evaluation. Based on the evaluation, she was diagnosed with multiple HTD at T8/9/10/11 without myelopathy (Figure 1).
The other patient, a 75-year-old man (case 2) complained of aggravation of a previously diagnosed postherpetic neuralgia. Extension of the previously symptomatic area forward upper dermatome was observed. Conservative treatment including radiofrequency treatment on the symptomatic dorsal root ganglion failed to relieve the symptoms. On T-spine MRI, a foraminal herniated disc at the left T9/10 level with a mild degree of disc protrusion at T8/9/10 was identified (Figure 2), which was compatible with his current symptoms. Both patient were successfully treated with transforaminal epidural block.
Conclusion
Multi-level HTD of the mid- to lower- thoracic spine may present as abdominal bulging with atrophy of the abdominal wall muscles. Concomitant PHN and HTD at adjacent thoracic levels may also occur. Thoracic transforaminal epidural blocks should be considered as a conservative therapeutic approach for HTD.
.jpg)
.jpg)