Non-traumatic Spontaneous Paraplegia Secondary to Thoracic Disc Herniations in the Setting of Tobacco Abuse and COVID-19: A Case Report and Literature Review
, 2022-11-15 02:00:00,
Thoracic disc herniations (TDHs) are very rare. While most common in the setting of trauma, other etiologies have been documented. Here, we present a case of spontaneous TDHs in the setting of tobacco abuse and coronavirus disease 2019 (COVID-19) causing acute paraplegia. We review spontaneous TDHs, associated risk factors, and the possible role of COVID-19 in the pathophysiology.
Introduction
Disc herniations are well-documented pathologies affecting roughly 50 per 100,000 people, most commonly involving the lumbar vertebrae, with thoracic disc herniations (TDHs) being a small subset [1]. TDHs comprise 0.5% to 4.5% of symptomatic disc herniations and only 0.15% to 1.8% of all surgically treated herniations [2].
The low incidence of TDHs in relation to other anatomic regions is related to the relative immobility and lower load-bearing demands of the thoracic spine. Both the coronal orientation of the facet joints and anchoring ribs provide stability with less repetitive trauma from physiological motion. Repetitive trauma of the more mobile cervical and lumbar regions contributes to degenerative changes over time. The resulting damage of the outer annulus fibrosis manifests in disc herniations among others. Furthermore, the thoracic spine has less weight-bearing load compared to the lumbar segments [2]. Within the thoracic spine, the lower thoracic segments bear the most axial load, and as a result, the most common levels for TDHs occur at T8-T12 (roughly 75% of the time). Large body habitus, as seen in our patient, contributes to increased load on all spinal levels, compounded at the lower thoracic levels and lumbar spine. The T11-T12 disc is the most common level for TDHs secondary to the increased axial load and increased mobility of the segment as it transitions to the lumbar spine. Additionally, given that T11-T12 is a transitional zone, the posterior longitudinal ligament has more laxity at this level compared to the rest of the thoracic spine, which is believed to further contribute to the higher incidence of TDHs occurring at this level [1].
Case Presentation
A 35-year-old male with a medical history of obesity, tobacco abuse, and recent diagnoses of coronavirus disease 2019 (COVID-19) presented to our hospital from an outside facility with a chief complaint of bilateral lower extremity weakness, onset eight hours prior to his arrival. The patient had no trauma or inciting events to bring upon this weakness. He noticed significant back…
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