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Final Program


Final Program

945 - Double Trouble: Concomitant Thoracic and Lumbar Disc Herniations

Friday, February 28, 2025
5:00 PM - 6:30 PM MST
Case Diagnosis: Concomitant Thoracic and Lumbar Disc Herniations

Case Description: A 58-year old male patient with presented to the emergency department after a mechanical fall in the shower onto his back. He had new onset lower extremity weakness, dysesthesias, and hyperreflexia. Imaging of his thoracic and lumbar spine revealed multilevel thoracic and lumbar disc herniations with displacement of thecal sac in the thoracic and lumbar spine with accompanying hyperintense signal in thoracic cord. The patient was seen by neurosurgery and underwent thoracic laminectomy, bilateral transpedicle resection of the herniated disc, and instrumented fusion for thoracic disc herniation with myelopathy with resolution of symptoms.

Discussions: Disc herniations concomitantly affecting two spinal regions are exceedingly rare with few cases in literature. Additionally, thoracic disc herniations constitute only 0.1% to 3% of all disc herniations. While lumbar disc herniations commonly follow traumatic incidents like ground-level falls, thoracic disc herniations are less frequently associated with such trauma and often present with severe neurological deficits and myelopathy. Of those with thoracic disc herniations, about 20% are estimated to present with multilevel thoracic disc herniations. Thoracic disc herniations are more likely to occur at lower thoracic levels and in some reports have had correlation with trauma in young patients and degenerative spines in older patients.

Conclusions: Our patient presents with a unique case of simultaneous thoracic and lumbar disc herniations. Tandem disc herniations in general are an exceedingly rare clinical phenomenon with few cases in literature, with this potentially being the only reported tandem herniation of both thoracic and lumbar discs. The patient’s myelopathy was recognized promptly and he underwent surgical intervention. Effective treatment requires addressing both acute exacerbations and underlying chronic disc pathology to optimize patient outcomes. Further research and larger case series are necessary to better understand the epidemiology and management strategies for this rare condition.