High thoracic disc herniation: a case-based discussion with a review of literature

Aim This article aims to describe a case of a 28-year-old male patient with progressively worsening of myelopathic symptoms owing to a large T4-5 thoracic disc herniation with severe cord compression. Background A 28-year-old male patient was referred to the clinic by a neurologist for worsening of bilateral lower extremity numbness, tingling, and progressive weakness over a period of few months with a clinical examination significant for severe myelopathy and imaging confirming a large thoracic disc herniation. Procedure T4-5 left hemilaminectomy and transfacet discectomy with unilateral right T4/T5 fixation and fusion were done. Outcomes The patient experienced delayed postoperative paraplegia that was reversible despite negative imaging studies, suggesting intraoperative incidental trauma to the cord or progressive postoperative cord edema. Scientific message Literature review of similar cases is presented as well as learning points from this challenging case. If the posterior approach is to be used, complete thorough decompression of the cord is advisable to minimize the risk of complications.