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Differences in clinical and radiological features of thoracic disc herniation presenting with acute progressive myelopathy.
European Spine Journal ( IF 2.8 ) Pub Date : 2020-06-07 , DOI: 10.1007/s00586-020-06485-6
Hideaki Nakajima 1 , Shuji Watanabe 1 , Kazuya Honjoh 1 , Arisa Kubota 1 , Akihiko Matsumine 1
Affiliation  

Purpose

Symptomatic thoracic disc herniation (TDH) is relatively rare, but patients with progressive myelopathy require surgical treatment without delay in diagnosis. The aim of this study was to review clinical and radiological features in patients with TDH presenting with myelopathy.

Methods

A total of 28 consecutive patients with thoracic myelopathy (Frankel grade C or worse) due to TDH who underwent surgery were divided into 3 groups based on the time for development of myelopathy (acute (< 72 h), subacute (within a few weeks), and chronic [gradually over > 1 month)] and their data were analyzed.

Results

The patients in the acute group were significantly younger and had a higher body mass index (BMI) compared to those in the subacute and chronic groups. Most cases of acute myelopathy were affected in the upper thoracic level, whereas all patients with subacute and chronic myelopathy had lesions in the lower thoracic level below T8–9. Interestingly, the affected thoracic level in patients with acute myelopathy matched the upper line of the sternum. The rate of acquired walking ability without assistance was only 50.0% in the acute group.

Conclusions

This study suggests that TDH presenting with acute myelopathy may have different clinical and radiological features compared to those of TDH with subacute and chronic myelopathy. Upper TDH should be suspected in cases of acute myelopathy that develops with sudden-onset back pain after certain triggers in younger and higher BMI people. These affected thoracic level matched with the upper line of the sternum in each case.



中文翻译:

表现为急性进行性脊髓病的胸椎间盘突出症的临床和放射学特征差异。

目的

有症状的胸椎间盘突出症(TDH)相对少见,但是进行性脊髓病的患者需要手术治疗而不会延迟诊断。这项研究的目的是审查TDH伴有脊髓病的患者的临床和放射学特征。

方法

根据发生脊髓病的时间(急性(<72小时),亚急性(几周内)),将总共28例因TDH手术而导致的TDH引起的胸椎脊髓病(法兰克C级或更严重)的患者分为3组。 ,以及慢性[逐渐超过1个月]]及其数据。

结果

与亚急性和慢性组相比,急性组的患者明显年轻,并且具有更高的体重指数(BMI)。多数急性脊髓病病例都在胸廓上部受到影响,而所有亚急性和慢性脊髓病患者的胸廓下部病变均在T8-9以下。有趣的是,急性脊髓病患者的胸廓水平与胸骨上线相吻合。急性组在没有帮助的情况下获得的步行能力的比率仅为50.0%。

结论

这项研究表明,与患有亚急性和慢性脊髓病的TDH相比,伴有急性脊髓病的TDH可能具有不同的临床和影像学特征。如果在年轻和更高BMI人群中某些触发因素导致突然发作的背痛而导致的急性脊髓病,则应怀疑TTD较高。在每种情况下,这些受影响的胸部水平与胸骨的上线相匹配。

更新日期:2020-06-07
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