title: Histologically proven acute paediatric thoracic disc herniation causing paraparesis: a case report and review of literature.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurosurgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK. jwalkden@doctors.net.uk.|, 27 Sutherland Street, Winton, Salford, M30 8BR, UK. jwalkden@doctors.net.uk.
authors.forename: James S
authors.initials: JS
authors.lastname: Walkden
authors.affiliation: Department of Neurosurgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Noble
authors.affiliation: Department of Neurosurgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
authors.forename: K H Carlos
authors.initials: KH
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Josan
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D020335:Paraparesis / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000601:surgery
keywords: Disc herniation; Paediatric; Thoracic spine; Trauma