title: Acute noncontiguous multiple-level thoracic disc herniations with myelopathy: a case report.
abstract: METHODS
  The case report of a 38-year-old man with a unique acute, triple-level, noncontiguous thoracic disc herniation (T6, T9-T10, and T11-T12), delayed onset of lower limb weakness, paresthesias below the T10 dermatome, and urinary dysfunction following minor trauma resulting from a motorcycle accident.
  
  
  OBJECTIVE
  To present an unusual case of herniation that could involve ambiguous test results (imaging findings not necessarily correlated with severity of clinical manifestations).
  
  
  BACKGROUND
  Multiple-level symptomatic disc herniations of the thoracic spine are rare, and the reported cases are mostly of contiguous, two-level lesions with chronic clinical presentation. No case of acute three-level noncontiguous ruptured thoracic disc herniations with myelopathy has been reported.
  
  
  METHODS
  Through the left transthoracic approach, partial corpectomy, complete discectomy, and interbody fusion of the T9-T10 vertebrae were performed. The less prominent lesions of the T6 and T12-L1 vertebrae were left untreated.
  
  
  RESULTS
  Remarkable improvement of neurologic symptoms, including motor weakness and bladder dysfunction, was observed 1 week after operation. At 1-year follow-up, he could walk without aid and with a somewhat spastic gait. However, paresthesias below dermatome T12 persisted. The patient refused to accept the recommendation of further surgical decompression of the nerves at the T6 and T12-L1 vertebral lesions.
  
  
  CONCLUSIONS
  Since the presentation of thoracic disc herniation is variable and difficult to correlate with imaging findings, decompression at all lesion levels in a patient with symptomatic multiple-level ruptured thoracic disc herniations may be necessary to achieve complete symptom relief and satisfactory results.
authors.affiliation: Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Cheng-Fong
authors.initials: CF
authors.lastname: Chen
authors.forename: Ming-Chau
authors.initials: MC
authors.lastname: Chang
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Liu
authors.forename: Tain-Hsiung
authors.initials: TH
authors.lastname: Chen
mesh_terms: D000063:Accidents, Traffic; D000208:Acute Disease; D000328:Adult; D019299:Decompression, Surgical; D017586:Diskectomy; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D009049:Motorcycles; D018908:Muscle Weakness / Q000209:etiology; D010292:Paresthesia / Q000209:etiology; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology