Week 49 - Acute myelopathy and posterior thoracic disc herniation as a result of advanced vertebral degeneration in adolescence: a case report
Guest Writer: Jesse Cross
By Lauren P. Yvellic PhD, Dr George N. Bonner, Dr Cecily Whitaker, Prof Matthew Brock and Caleb Fulton
Abstract
We present a rare case of posterior disc herniation at Th5/6 with acute myelopathy and motor deficits caused by advanced vertebral degeneration in a young adult patient. The patient suffered from a hyperkyphotic posture and advanced vertebral degeneration developed across a 12-month period.
Vertebral degeneration at the thoracic level causing disc herniation has been discussed in case reports previously; an advanced degeneration of vertebral bodies as a result of postural scoliosis leading to structural defect of the vertebral has never been described in literature before.
Keywords: Vertebral degeneration, Adolescents, Thoracic spine
Background
It is well established that poor posture sustained over time may affect the physiological development of the spine [4]. This is frequently demonstrated with the increase of age, as degeneration of the spine is a condition seen more frequently among older demographics [3]. With this degeneration of the spine, it is common that posture is negatively affected. [2, 7, 16]
Thoracic disc herniation rarely occurs in adolescents, and even more rare still should it present symptomatically; accounting for only 0.1 to 3% of spinal disc herniation. symptomatic presentations most commonly present as signs of myelopathy (50-80%) [8, 9, 14].
There have been few cases of vertebral degeneration causing posterior herniation resulting in myelopathy in adolescents. Of those cases, the majority can be accounted for through structural scoliosis due to defects present at birth; morphological or genetic. We present the rare case of postural scoliosis leading to advanced deterioration of the vertebral bodies causing a posterior extrusion of the intervertebral disc resulting in hernia, leading to myelopathy and the degenerative wedging of vertebral bodies in a young adult patient. The wedging of vertebral bodies is seen commonly in structural scoliosis and postural conditions such as Scheuermann's disease - though these conditions and the patient's presentation in this case study are believed to be separate.
This week of The Creature was written by Jesse Cross. Find their work on Instagram @_exkles