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Spontaneous Regression And Near Disappearance Of A Calcified Herniated Thoracic Disc In A 44-year-old Male: Illustrative Case

Utter, A. 2021Other/Unknown

Utter, A., Cavanaugh, D., Van Schouwen, K. F., Mascagni, M., Walker, M., & Stone, M. (2021). Spontaneous regression and near disappearance of a calcified herniated thoracic disc in a 44-year-old male: illustrative case. Journal of neurosurgery. Case lessons, 1(19), CASE2130. https://doi.org/10.3171/CASE2130

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Abstract

BACKGROUND: Herniation of an intervertebral disc (IVD) is found predominantly in the lumbar and cervical spine of both children and adults, but herniated IVDs of the thoracic spine are a rare occurrence. However, approximately 40% of herniated thoracic disc cases are calcified. Approximately 0.65% of all spinal herniations are calcified herniated thoracic discs (CHTDs). CHTDs can be treated conservatively or invasively, depending on the symptoms and degree of neurological deficit present. OBSERVATIONS: The authors report a 44-year-old male with near complete reabsorption and disappearance of a CHTD. A review of the available literature indicates that there are only seven adult patients in whom this phenomenon has been reported. LESSONS: Determining the best form of invasive treatment is a challenge for surgeons given the complexity of this condition. While the disappearance of calcified herniated discs of the lumbar and cervical spine has been reported, reports of the regression of CHTDs are rare. The disappearance of CHTDs is more commonly reported in children who undergo conservative treatment, while surgery is reserved for children who experience progressive pain and neurological deficit. Given the success of conservative treatment of CHTDs in children, conservative treatment methods should be considered when treating mildly symptomatic adults.

Case Details

Disease Location

T9-t10 intervertebral disc

Personal Characteristics

44-year-old male

Clinical Characteristics

Presented with thoracic back pain. The onset of pain was sudden and occurred while he was sitting at his desk chair 5 months before he received ketorolac tromethamine shots and steroid injections in his arm and buttock, which he reported did not help with his pain. MRI showed an extradural mass, initially thought to be a soft thoracic disc herniation, that measured 1.3 cm at the t9–10 level on the right side. The mass demonstrated cord compression.

Remission Characteristics

2-years-later, a thoracic spine MRI showed the central spinal canal and neural foramina to be intact throughout, with disappearance of the calcified herniated thoracic discs (chtd) at t9–10.

Treatment & Mechanisms

Clinical Treatment

Ketorolac tromethamine, steroid injections,

Non-Clinical Treatment

Physical therapy