James S Walkden1,2, Graham J Noble3, K H Carlos Chung3, Vivek A Josan3. 1. Department of Neurosurgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK. jwalkden@doctors.net.uk. 2. , 27 Sutherland Street, Winton, Salford, M30 8BR, UK. jwalkden@doctors.net.uk. 3. Department of Neurosurgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
Abstract
PURPOSE: We describe an extremely rare and previously unreported presentation of acute progressive paraparesis secondary to traumatic thoracic disc herniation in a child presenting to our institution. METHODS: A 12-year-old girl presented with progressive paraparesis 24 h after falling from standing height while playing at school. She was being lifted up by her friends and fell landing on her feet then rolled onto her back initially with no pain or neurological sequelae. Over the next few hours, she developed back pain followed by progressive paraparesis associated with urinary retention and sensory impairment. RESULTS: MR imaging demonstrated an unusual lateral and dorsally based lesion at T7/8 causing cord compression which was thought to represent an epidural haematoma. Urgent posterior decompressive surgery was performed but no evidence of haematoma was seen, a large well-circumscribed solid piece of soft tissue was found in the extradural space causing significant cord compression. This was sent for histological analysis and subsequently reported as showing cartilaginous disc material. Postoperative MR imaging at 2 weeks and 3 months demonstrates complete resection of this disc material with no significant kyphotic deformity on standing X-ray at 18 months. Complete neurological recovery occurred over the subsequent 3 months following emergent surgery, and at 18-month review, the patient remains asymptomatic and fully independent.
PURPOSE: We describe an extremely rare and previously unreported presentation of acute progressive paraparesis secondary to traumatic thoracic disc herniation in a child presenting to our institution. METHODS: A 12-year-old girl presented with progressive paraparesis 24 h after falling from standing height while playing at school. She was being lifted up by her friends and fell landing on her feet then rolled onto her back initially with no pain or neurological sequelae. Over the next few hours, she developed back pain followed by progressive paraparesis associated with urinary retention and sensory impairment. RESULTS: MR imaging demonstrated an unusual lateral and dorsally based lesion at T7/8 causing cord compression which was thought to represent an epidural haematoma. Urgent posterior decompressive surgery was performed but no evidence of haematoma was seen, a large well-circumscribed solid piece of soft tissue was found in the extradural space causing significant cord compression. This was sent for histological analysis and subsequently reported as showing cartilaginous disc material. Postoperative MR imaging at 2 weeks and 3 months demonstrates complete resection of this disc material with no significant kyphotic deformity on standing X-ray at 18 months. Complete neurological recovery occurred over the subsequent 3 months following emergent surgery, and at 18-month review, the patient remains asymptomatic and fully independent.