#best thoracic myelopathy treatment

[indospinehospital]

Affordable Thoracic Myelopathy Treatment in Ahmedabad

IndoSpine Hospital is the best hospital for affordable thoracic myelopathy treatment in Ahmedabad. Our spine experts carefully analyze the root cause of the conditions and draft an effective treatment plan based on it. Our spine hospital is equipped with all the machines and devices required for various examinations and diagnoses. Book your appointment today.

[brisbanehipnkneeau]

Top Doctors You Should Know About

Choosing a top doctors greenslopes can be one of the most difficult tasks a person may ever have to face. And it is even harder if you are relying on awards and reviews to find a reputable doctor.

A recent ABC News report explains how some of these awards are meaningless and can be rigged by doctors who have financial relationships with the award companies.

1. Dr William A. Abbas

Dr Abbas is a doctor who focuses on treating patients of all ages. He provides preventive care, including routine checkups and tests, as well as coaching them on how to live healthier lives.

He is experienced in many medical conditions, including heart disease and cancer. He is also skilled in helping patients manage their diabetes, asthma and other chronic health issues.

His patient-centered approach makes him one of the best doctors in his field, and he values the time he has with his patients. He believes that a doctor-patient relationship should last long enough for him to thoroughly evaluate each patient’s health and answer their questions and concerns.

He has a wide range of experience in thoracic surgery, including robotic thoracic surgery and advanced thoracic endoscopy. He is also known for his expertise in foregut diseases, such as esophageal motility disorders and complex antireflux procedures. He is a member of the American College of Thoracic Surgeons and the Society for Robotic Thoracic Surgery.

2. Dr Khalid Abbed

Dr Khalid Abbed is a neurosurgeon who specializes in the treatment of conditions that affect the nervous system. He provides invasive and minimally invasive surgical procedures for disorders such as traumatic brain injuries, tumors, and Parkinson’s disease.

He has 24 years of experience and works at Hartford HealthCare Medical Group in Bridgeport, CT. He treats patients in New Haven and Stamford.

In his practice, Dr Abbed frequently treats Low Back Pain, Radiculopathy (Not Due to Disc Displacement), and Cervical Spine Myelopathy. He accepts most insurance plans and is accepting new patients.

He joined Hartford HealthCare on March 16 from Yale School of Medicine where he was a professor, clinical vice chair, and chief of spine surgery. He will also serve as co-physician-in-leader of the Ayer Neuroscience Institute. He will oversee neurosurgical services and lead the institute’s expansion into Fairfield County and throughout Connecticut. He is skilled in the minimally-invasive treatment of spine ailments and will work with healthcare leaders to improve patient care and develop less invasive, more intelligent medical technologies.

3. Dr John Burris

Dr John Burris is a preventative medicine specialist practicing in Vail, CO. He participates in the planning and evaluation of health services, researches diseases in specific populations, and helps manage health care organizations.

He is also a neonatologist, and his clinical and research interests include care of complex newborns, nutrition in breastfed infants, improvement in respiratory outcomes of premature neonates, and graduate medical education. He is also an associate director of the Complex Delivery Service at GCH, and spearheaded the initiation of less invasive surfactant administration in the GCH NICU which now is the standard of care for infants meeting criteria for surfactant deficiency.

He has been in practice for over 28 years, and receives good ratings from patients. They say he explained their conditions well and didn’t rush them through their appointment.

4. Dr Akhtar

Dr Akhtar is a hematologist and medical oncologist with extensive experience in treating patients with blood disorders. He provides chemotherapy, pain management, access to clinical trials and follow-up care.

His passion for the field of medicine was sparked by his parents, respected physicians. He strives to live up to the same standards, and he is committed to providing compassionate and exemplary medical care for all patients.

He is board-certified in hematology, internal medicine and oncology. His special interests include treatment of cancer, blood disorders and bone marrow transplants.

In addition to his private practice, he is also Director of the Orangi Pilot Project (OPP) in Karachi, Pakistan. The OPP focuses on assisting disadvantaged people in low-income settlements to lift themselves out of poverty. The program is based on participatory development, poverty alleviation, microfinance, endogenous rural development, and grassroots approaches to development. It has been replicated in various parts of the world and continues to be implemented today.

[ourhaileydavies]

Juniper Publishers-Open Access Journal of Head Neck & Spine Surgery

Spontaneous Regression of a Large Symptomatic Calcified Central Thoracic Disc Herniation: A Case Report with a Review of the Literature

Authored by Manuel R Pinto

Abstract

Disc herniations in the thoracic spine are rare and the incidence of symptomatic thoracic disc herniation (TDH) is 1 in a million. The incidence of asymptomatic TDH varies from 11-13%. They are classified as small (≤10%), medium (11-20%), large (21-40%), or giant (≥41%) based on the extent of canal compromise on advanced imaging. The large symptomatic calcified central TDHs are best treated operatively, as the disc fragment could be adherent to the dura or remain intra-dural [1]. We hereby report a case of one such large central calcified TDH at the T7-T8 level in a 46 year old gentleman who presented with axial mid-thoracic back pain and right-sided radicular symptoms along the intercostal nerve distribution, in addition to tingling and numbness in his lower extremities. The calcified extruded intra-dural disc fragment regressed spontaneously over two and half months, while the patient was waiting for a scheduled elective decompression surgery. The relevant MRI and CT scan images with a review of the salient literature are discussed. We believe this to be the first such case of a spontaneous regression of a large symptomatic central calcified TDH to be reported in English literature that is documented with CT and MRI scans.

Keywords: Disc herniation; Calcification; Thoracic spine; Spontaneous regression; Radiculopathy; Myelopathy

Introduction

The thoracic spine is the least common region to present with a disc herniation in comparison to cervical and lumbar regions. Majority of thoracic disc herniations (THDs) are asymptomatic and detected incidentally on magnetic resonance imaging (MRI). The incidence of asymptomatic TDH varies from 11-13% [2]. They are classified as small (≤10%), medium (11-20%), large (21-40%), or giant (≥41%) based on the extent of canal compromise on advanced imaging studies (i.e. CT and MRI) [1,3]. Thoracic disc herniations (TDHs) are rare and most commonly affect the thoraco-lumbar junction, with the T11-T12 disc being the most frequently herniated due to the greater spinal mobility and weakness of the posterior longitudinal ligament [4]. Up to 75% of thoracic disc herniations occur below the T8 vertebra, and herniation of the upper thoracic spine is very rare. A large proportion of TDHs are asymptomatic and little is known regarding the natural history of symptomatic TDHs. They affect older individuals most commonly, and a history of a precipitating event or trauma is often absent in at least half to two-thirds of the affected individuals [5]. The symptoms are secondary to chronic spinal cord compression with the calcification of an extruded fragment suggestive of co-existent degenerative changes. Younger individuals may present with a soft disc herniation and a history of acute trauma or a precipitating event that is responsive to non-operative management. Patients with a TDH may present with axial back pain, radiculopathy, and/or myelopathy with a neuro deficit. Males are more commonly affected than females, and surgery is the treatment of choice for large symptomatic calcified central TDHs [6]. The discectomy of TDHs constitutes 0.15-4% of all disc surgical procedures and the intra-operative localization of the correct surgical level is challenging [7]. A spontaneous regression of a large symptomatic calcified central TDH is rare and no case report exists to this day to the best of our knowledge in English literature. We hereby report one such case of a spontaneous resorption of a large symptomatic calcified central T7-T8 TDH in a 46 year old gentleman with relevant MRI and CT image illustrations. A review of the relevant literature with some of the proposed theories explaining such a spontaneous regressive phenomenon is also discussed.

Case Report

A 46 year old, right hand dominant academician presented with a seven month history of axial mid-thoracic back pain with discomfort and occasional radicular pain around the right hemi-thorax to the senior author’s office (MRP). The pain was associated muscle spasms on the right side of midline that warranted the intake of non-steroidal anti-inflammatory drugs (i.e. NSAIDs). He had tried a structured physical therapy program and chiropractic treatment for few months, which was marginally helpful in alleviating his symptoms. The pain was aggravated during activities that involved vibration and jarring (especially travelling), and his symptoms were partially relieved with rest and NSAIDs. Increasingly, over the recent three months, he began getting tingling and numbness in his lower extremities that initiated this consultation in our office. His Oswestry disability index (ODI) at the first clinic visit was 32%. The back pain: radicular hemi-thoracic pain ratio was 70:30 at the time of his first consultation. He denied co-existent red flag signs (i.e. bladder or bowel involvement and foot drop). His past medical history was significant for arthritis, hypertension, and type II diabetes mellitus. His past surgical history included a herniorraphy in his early twenties for an inguinal hernia. He was otherwise in good health and denied any recent history of weight loss, night pains, loss of appetite, fever with night sweats, or chills and rigors. At his most recent annual physical check-up, the assessment by his primary care physician was negative for any concerns of malignancy, hemochromatosis, hyperparathyroidism, gout, pseudogout, and hypercalcemic states. His personal history was negative for the use of tobacco products and his alcohol consumption was minimal (<3 drinks per week).

On clinical examination by the senior author (MRP), he had some midline tenderness in the mid-thoracic region over the spinous processes with a good range of motion (ROM) of both the cervical and lumbar spine. Motor strength testing revealed normal strength, tone and power (i.e., Medical Research Council [MRC] grade 5/5 motor strength) in his lower extremities. He had right-sided radiculopathy/anterior-chest band like discomfort with hemi-thoracic tenderness along the course of the T7- T9 dermatomal distribution. His right shoulder and scapular function were normal and negative for intrinsic shoulder pathology. The deep tendon reflexes in his knees and ankles were normal. The Romberg’s sign was negative, his gait was normal, and he effortlessly performed tandem-walking.

A working diagnosis of a potential space occupying lesion (SOL) in the thoracic region, causing mechanical compression of the spinal cord and/or nerve root(s), was suspected. An immediate MRI scan was arranged, which revealed a large mass causing the ventral effacement of CSF flow / signal at the T7- T8 level. His T2 weighted MRI images are illustrated in (Figure 1a & 1b). The differential diagnosis included disc herniation and other benign intra-axial neoplasms (i.e. meningioma and schwannoma). A CT scan was requested to further understand the lesion, study the extent of calcification / bony, and the intradural involvement (if any). The key CT sagittal and axial images are depicted in (Figure 2a & 2b). From these, the diagnosis narrowed down to a large central calcified TDH, following a discussion at the multi-disciplinary team (MDT) meeting.

The patient was seen at the office a week later to discuss the results of his CT and MRI scans. The natural history of disc herniation, available treatment options, risks, complications, prognosis, including watchful waiting, were extensively discussed. Surgical management, using an anterior trans-thoracic approach with a vascular co-surgeon for access, was discussed at length. A surgical discectomy with decompression was recommended and offered, given that he was persistently symptomatic with lower extremity tingling and numbness for at least three months, and because non-operative treatment failed. He chose to electively schedule the surgery in two months (seeking time off work for his post-operative recovery and making alternative arrangements for his academic/professional commitments) with an understanding that it would be undertaken immediately should there be a change in neurology and/or any bladder and bowel involvement.

He was seen in the pre-assessment clinic two weeks prior to the scheduled surgical date, reporting spontaneous improvement in his back pain and anterior-chest band like tightness, and with a resolution of his lower extremity tingling/numbness. His ODI was 4%. The proposed surgery was withheld and an interval MRI scan of his thoracic spine was requested. The T2 weighted images at two months from his initial MRI revealed the regression of the large central calcified TDH and this is illustrated in (Figure 3a & 3b). He had a complete resolution of his symptoms while waiting for surgery and he had normal neurology.He signed a written consent form and permitted us to submit and publish his clinical course of events as a case report provided he remained anonymous.

Discussion

We have reported a case of a large central calcified TDH that has spontaneously regressed over four and half months while the patient was waiting for surgical decompressive surgery. The treatment of choice for a symptomatic large central calcified TDH is operative excision by the anterior trans-throacic approach [8]. Spontaneous regressions of such central calcified discs are very rare and we believe this to be the first such reported case in English literature. The only other case report we could identify in English was a calcified right-sided foraminal T7-T8 TDH with a nucleus pulposus calcification in a 36 year old woman that regressed spontaneously over three months, as reported by Piccirilli et al. [9]. Though interestingly, our case also had the disc herniation occur at the same level (i.e. T7-T8), but it was strikingly different and unique in several aspects, in that our case had

A large central calcified TDH,

The absence of nucleous pulposus calcification, and

A decade older male patient (46 year old gentleman vs. 36 year old woman).

The pathogenesis of this rare phenomenon of spontaneous resorption is poorly understood. Proposed theories postulated to explain it include [10-12]:

Dehydration of the herniated fragment and its subsequent resorption,

Activation of the inflammatory process leading to degradation and resorption,

Re-accommodation of the nucleus pulposus in the inter vertebral disc space, or

The bathing of extruded disc material in epidural space by blood vessels, which facilitate neovascularisation and eventual macrophage infiltration with phagocytosis.

The clinical course of a TDH is variable, and a patient can present with non-spinal symptoms and an atypical pain pattern mimicking other organ system involvement to frank myelopathy. Though the spinal cord is smallest in diameter in the thoracic region, the cord: canal ratio is at least 40% compared to 25% in the cervical region, which make sit sensitive to compressive effects [4]. Varying degrees of myelo-radiculopathy, Brownsequard syndrome to paraplegia are reported with symptomatic TDHs [13]. The incidence of bladder and/or bowel involvement in TDHs varies from 15-20%. A high degree of clinical suspicion, supplemented by a thorough history, physical examination, and confirmation by the appropriate diagnostic imaging, is essential for accurate diagnosis.

Calcification of inter vertebral discs could potentially occur at three places:

The annulus fibrosus,

The fibro cartilaginous plate, and

Centrally in the nucleus pulposus.

Von Lushka was the first to describe this phenomenon in adults and observed such calcifications, especially in the annulus fibrosus, to be almost always asymptomatic [14]. The calcification of the nucleus pulposus is secondary to the deposition of amorphous calcium salts in degenerated tissue and might regress spontaneously, especially in children. Disc calcification also correlated significantly with the morphologic degree of degeneration. CT myelography is considered to be the investigation of choice for the evaluation of calcified TDHs, as it demonstrates the degree of canal encroachment / intra-dural extension better than other imaging modalities [15].

Giant TDHs occupy at least 40% of the canal dimensions and were first defined by Hott et al. [3]. They produced severe neurological deficit and were associated with poor functional outcome compared to small and medium TDHs. The authors recommended open thoracotomy, rather than thoracoscopy, in treating such giant calcified TDHs. Barbanera et al. [16] reported a series of 7 patients who had symptomatic giant calcified TDHs and none of them regressed spontaneously. Brown et al. [17] evaluated 55 patients with symptomatic TDHs and observed only 15 patients needed surgery (27%). Encouraged by those findings, they recommended a less aggressive surgical approach, as TDHs did not necessarily cause severe neurological compromise. Wood et al. [2] studied the natural history of asymptomatic TDHs and recommended mere observation to be justifiable, even in symptomatic individuals whose chief complaint was axial spinal pain. Outside of English literature, we identified only four cases (three publications) of a spontaneous resorption of a TDH in the French and Italian languages.

Coevoet et al. [18] reported a case of a T9-T10 protrusion that regressed spontaneously over 13 months. Martinez-Quinone et al. [19] reported a case of a T6-T7 TDH in a 47 year old male that regressed spontaneously. Neither of the two reports specified if those discs were calcified. Eap et al. [20] reported two cases of a spontaneous resorption of a calcified TDH. They included a left T8-T9 foraminal herniation in a 48 year old and a large central T12-L1 herniation (similar to our case) in a 45 year oldpatient.

Komori et al. [21] observed extensive rim enhancement on follow-up MRI imaging to be predictive of spontaneous resorption. A gadolinium enhanced diethylenetriaminepentaacetic acid (Gd- DTPA) MRI could be used to evaluate the neovascularisation zone and might give an insight into the dynamics of disc resorption. Auito et al. [22] studied the determinants of spontaneous resorption in lumbar disc herniation by longitudinal Gd-DTPA enhanced MRI scans, focusing on the rim enhancement zone, and they observed that a higher rim enhancement thickness, a higher degree of HNP displacement, and the age group of 41-50 years to be associated with better resorption rate. The clinical symptom alleviation correlated well with the rate of disc resorption, and dramatic clinical improvement was seen at the end of two months. Unfortunately no such studies have been reported until now for TDHs.

Conclusion

In summary, a large symptomatic calcified central TDH can be treated with careful observation, as long as the patients are capable of coping with the pain and do not have any lower extremity motor weakness or other red flag signs. A better understanding of pathomechanisms that attempt to further elucidate the complex interplay between disc calcification, disc angiogenesis, and disc degeneration is desired, so that strategies are developed to predict disc herniations that regress spontaneously. Studies focusing on investigating such link mechanisms are desired and constitute grounds for further research. Such studies might also explain which TDHs would most likely regress on their own and define the role of surgery vs. non-operative treatment in the management of symptomatic large central calcified TDHs.

For more articles click on: https://juniperpublishers.com/jhnss/index.php

[spineandbrainindia]

How to Find Best Brain Tumor Treatment Hospital in India ?

Treatment for a brain tumor differs depending on several factors such as a person's age, general health, and the size, location, and type of tumor. Treatment of brain cancer is usually complex. Most treatment plans involve several consulting doctors. Surgery to remove the tumor is typically the first option once a brain tumor has been diagnosed. The purpose of surgery is to confirm that the abnormality seen during testing is indeed a tumor and to remove the tumor. If the tumor cannot be removed, a sample of the tumor will be taken to identify its type. Radiation and chemotherapy are other modalities may also be used.​  Spine and Brain India directed by Dr. Arun Saroha offers one of the best brain tumor treatment in India.

Delhi is a hub for medical tourists flocking in from all corners of the world to receive superlative treatment from the best in the field. Dr. Arun Saroha is a noted neurosurgeon available in Delhi and Gurgaon with over 20 years of experience treating a wide variety of neurological conditions varying from acute pain to the most complex spinal deformity in both adult and pediatric patients. He has successfully performed over 7000 procedures with patients from different parts of the world. He is one of the best brain tumor doctor in Delhi who has the highest expertise in treating different types of brain tumor in adults as well as pediatric patients. He is well known for recommending the most effective and safest treatment options, delivering expert care tailored to the needs of the individual patients.

Dr. Arun Saroha is the Director of Neurosurgery at Max Hospital, Saket New Delhi and Gurgaon. Max Hospital is one of the top hospital in India offering the best brain and spine treatment using the latest technologies that increases the precision of the surgeon’s work and thereby improving the outcome of the treatment. In addition to the advanced technologies being utilized, correct diagnosis is the key to effective treatment. Doctors in India are known for their accurate diagnosis and best treatment at affordable rates as compared to Western countries.

The best brain surgeon in Delhi and Gurgaon, Dr. Arun Saroha, is also one of the very few in the country who treats pediatric neurosurgical conditions, including hydrocephalus, chiari I malformations, a rachnoid cysts, spine disorders including tethered cord, spinal tumors, vascular malformations, head and spine trauma. The particular types of brain conditions that arise in children differ in important ways from those found in adults. For children, particular risks and benefits correspond to particular treatments in ways that may be different than for adults.

Most of the hospitals in India are internationally accredited, thus enhancing customer’s access to better healthcare services and meeting their expectations. The accredited healthcare organization practices and delivers continuous quality services and functions in the best interests of all patients giving importance to access, affordability, efficiency and quality healthcare services.

Spine and Brain India headed by Dr. Arun Saroha, one of the best brain surgeon in Delhi and Gurgaon is dedicated in providing comprehensive diagnosis and treatment for all types of brain and spine conditions including Cervical, Thoracic and Lumbar Disorders, Disk Herniation, Spinal Stenosis, Spondylolisthesis, Spondylotic Myelopathy, Brain and Spine Trauma, Brain Tumors for both adult and pediatric patients. 

[cherubcomets]

My best friend and her step mom have opened an etsy store in order to cover their pug’s treatment. Their pug, Friday, was diagnosed with herniated discs in his lumbar and thoracic regions. He had a diagnostic CT scan and they are now waiting to find out if the neurologist recommends surgery. They’re also waiting to find out the results of a blood test, which will tell if he has degenerative myelopathy, which is basically a canine version of ALS, or Lou Gehrig’s disease. His surgery and treatment will be very costly and they need any help they can get in order to cover the costs. All of the money made from the etsy store will go toward Friday’s treatment. Any additional money after his treatment is covered will go toward the organization Pug Rescue of Florida (PROOF, http://pugrescueofflorida.org/ ) Friday means the world to my best friend and her family. Anyone who has owned a dog knows how important they are. Please purchase a bracelet if you’re able to (theyre aromatherapy bracelets !!) or simply share this post. Thanks! Etsy store - http://etsy.me/2oiLRzr

[latricepcox]

What is Conservative Treatment for a Herniated Disc?

The term “conservative treatment” means that the treatment used to address an issue, such as a herniated disc in the lower back, is non surgical in nature and consists of other alternatives such as injections, medications, and physical therapy.

Herniated Discs Conservative Treatment New York NY – Better Health Chiropractic

Chiropractic treatments focus on providing conservative, alternative care for neck, back, and other spinal discomfort and conditions. The majority of conservative herniated disc treatment options are used in conjunction with others in order to achieve the best possible results. The ultimate goal of non-surgical lumbar decompression and other similar treatments is to help patients alleviate their pain and experience a healthier back and spine.

In cases where non-surgical treatment for herniated discs are not advised due to immediate danger and need for emergency care, surgery may still be the necessary choice. However, in most cases, surgical intervention is only used when conservative treatments do not provide the necessary relief.

Herniated Discs Conservative Treatment NYC – Better Health Chiropractic

What is a Cervical Herniated Disc?

A cervical herniated disc occurs when the inner part of the disc herniates, or starts to leak outwards. This puts pressure on the surrounding nerves and occurs primarily in those between 30 and 50 years of age. While they can be caused due to injury, most occur for seemingly no reason at all.

Arm pain is a common symptom of cervical herniated discs, a symptom that is caused by pressure on the cervical nerve. Along with pain, tingling and numbness are also common as is muscle weakness.

Since the discs are in relative close contact with the nerves and not a lot of “free space” is present in the area, even the smallest herniation can cause intense pain.

What is a Thoracic Disc Herniation?

A herniated disc in the thoracic spine occurs when the inner material of a disc leaks. The result is often moderate to severe pain in the upper back as well as numbness and radiating discomfort. The type of pain experienced can vary depending upon the location of the herniation. The following are the most common symptoms experienced for:

Central disc protrusion: upper back pain (myelopathy)

Lateral disc herniation: radiating abdominal and chest wall pain

Centro-lateral disc herniation: upper back pain, radiating pain, myelopathy

Thoracic back pain can be present in a number of forms, and can be easily exacerbated when either sneezing or coughing. Pain can radiate throughout the body, especially in the chest and gut, which can make diagnosis challenging. Oftentimes, what ends up being a herniated disc in the thoracic spine is originally mistook for a heart, kidney, gastrointestinal, or lung problem.

There are many issues and disorders of the spine that can sometimes present with similar symptoms, which can make diagnosis tricky as well. These include infection, metabolic disorders, spinal fractures, and the like. This is why visiting a chiropractor can be so beneficial and can help you to determine whether the issues you’re experiencing are chiropractic in nature.

What is a Lumbar Disc Herniation?

A herniated disc in the lower back, or a lumbar disc herniation, can be yet another cause for seeking out the assistance of a disc herniation specialist. These discs are integral in helping to absorb vertebral shock, supporting the upper body, and allowing for multi-directional movement.

When a herniated disc in the neck or lower back starts to leak, the disc can quickly begin to aggravate nearby nerves and cause moderate to significant pain throughout the body. Pain due to lumbar disc herniation often occurs out of the blue for no reason at all. It often becomes apparent after participating in a grueling activity such as lifting heavy objects or even simple, everyday motions like twisting the lower back. These kinds of movements can exacerbate a slipped disc, bulging disc, or other spinal injuries.

Lumbar disc issues, similar to a herniated disc in the neck, are most common in individuals who are between the ages of 35 and 50. As people age, it’s more likely for individuals to develop a bulging disc, slipped disc, or herniation. Since discs typically lose fluid over time, they become less pliable, harder, and more prone to damage. Disc degeneration, which causes these types of changes, begins relatively early in life.

Like in the case of a herniated disc in the thoracic spine, lumbar herniations can cause a number of side effects. Since the herniation often places pressure on the spinal nerve root, the result can be intense, shooting sciatic pain in the legs and buttocks.

Fortunately, non-surgical treatment for herniated discs can often treat lumbar herniations and the symptoms rarely last longer than a month. There are three primary reasons why these types of spinal injuries and issues aren’t long-lasting: (1) The body fights against the herniation which makes it shrink in size. (2) Water from within the disc is resorbed which causes the disc to shrink and the nerves to be affected far less. (3)Specific exercises have been shown to move the herniation away from the discs themselves.

Herniated Discs Conservative Treatment – Chiropractic Consultation

Schedule a Consultation with Dr. Eingorn about Herniated Discs Conservative Treatment

Dr. Eingorn is a chiropractor who has over 25 years of experience treating patients who are dealing with neck or back injuries through the use of spinal decompression. His focus is on helping individuals who are living with herniations that require the assistance of a disc herniation specialist.

If you’ve been living in pain, it’s time to reach out for professional assistance. Herniations do not heal themselves without decompression or other similar treatments, so seeking help is a must. Dr. Eingorn takes a very thorough approach to chiropractic care and offers a number of non-surgical lumbar decompression treatments. Decompression is a proven technique that Dr. Eingorn has used to help patients who are living with a herniated disc and other similar spinal injuries and issues.

To schedule an appointment to learn more about spinal decompression and the other herniated disc treatment options available to you, give the office of Dr. Eingorn a call today at 646-553-1884.

Herniated Discs Conservative Treatment

Areas of Service

Dr. Eingorn and Better Health Chiropractic (https://betterhealthchiropracticpc.com) provide conservative treatment for disc herniations of the lower back, upper back, and neck for patients from these areas of NYC:

Manhattan, NYC, Midtown NY, Battery Park City NY, Financial District NY, TriBeCa NY, Chinatown NY, Greenwich Village NY, Little Italy NY, Lower East Side NY, NoHo NY, SoHo NY, West Village NY, Alphabet City NY, Chinatown NY, East Village NY, Lower East Side NY, Two Bridges NY, Chelsea NY, Clinton NY, Gramercy Park NY, Kips Bay NY, Murray Hill NY, Peter Cooper Village NY, Stuyvesant Town NY, Sutton Place NY, Tudor City NY, Turtle Bay NY, Waterside Plaza NY, Lincoln Square NY, Manhattan Valley NY, Upper West Side NY, Lenox Hill NY, Roosevelt Island NY, Upper East Side NY, Yorkville NY, Hamilton Heights NY, Manhattanville, Morningside Heights NY, Harlem NY, Polo Grounds NY, East Harlem NY, Randall’s Island NY, Spanish Harlem NY, Wards Island NY, Inwood NY, Washington Heights NY

The post <span lang ="en">What is Conservative Treatment for a Herniated Disc?</span> appeared first on NYC Chiropractor – Better Health Chiropractic New York – Call 646-553-1884.

This blog post originally appeared here: http://bit.ly/2WQ3Nlt

[bettyvwilliam]

What is Conservative Treatment for a Herniated Disc?

The term “conservative treatment” means that the treatment used to address an issue, such as a herniated disc in the lower back, is non surgical in nature and consists of other alternatives such as injections, medications, and physical therapy.

Herniated Discs Conservative Treatment New York NY – Better Health Chiropractic

Chiropractic treatments focus on providing conservative, alternative care for neck, back, and other spinal discomfort and conditions. The majority of conservative herniated disc treatment options are used in conjunction with others in order to achieve the best possible results. The ultimate goal of non-surgical lumbar decompression and other similar treatments is to help patients alleviate their pain and experience a healthier back and spine.

In cases where non-surgical treatment for herniated discs are not advised due to immediate danger and need for emergency care, surgery may still be the necessary choice. However, in most cases, surgical intervention is only used when conservative treatments do not provide the necessary relief.

Herniated Discs Conservative Treatment NYC – Better Health Chiropractic

What is a Cervical Herniated Disc?

A cervical herniated disc occurs when the inner part of the disc herniates, or starts to leak outwards. This puts pressure on the surrounding nerves and occurs primarily in those between 30 and 50 years of age. While they can be caused due to injury, most occur for seemingly no reason at all.

Arm pain is a common symptom of cervical herniated discs, a symptom that is caused by pressure on the cervical nerve. Along with pain, tingling and numbness are also common as is muscle weakness.

Since the discs are in relative close contact with the nerves and not a lot of “free space” is present in the area, even the smallest herniation can cause intense pain.

What is a Thoracic Disc Herniation?

A herniated disc in the thoracic spine occurs when the inner material of a disc leaks. The result is often moderate to severe pain in the upper back as well as numbness and radiating discomfort. The type of pain experienced can vary depending upon the location of the herniation. The following are the most common symptoms experienced for:

Central disc protrusion: upper back pain (myelopathy)

Lateral disc herniation: radiating abdominal and chest wall pain

Centro-lateral disc herniation: upper back pain, radiating pain, myelopathy

Thoracic back pain can be present in a number of forms, and can be easily exacerbated when either sneezing or coughing. Pain can radiate throughout the body, especially in the chest and gut, which can make diagnosis challenging. Oftentimes, what ends up being a herniated disc in the thoracic spine is originally mistook for a heart, kidney, gastrointestinal, or lung problem.

There are many issues and disorders of the spine that can sometimes present with similar symptoms, which can make diagnosis tricky as well. These include infection, metabolic disorders, spinal fractures, and the like. This is why visiting a chiropractor can be so beneficial and can help you to determine whether the issues you’re experiencing are chiropractic in nature.

What is a Lumbar Disc Herniation?

A herniated disc in the lower back, or a lumbar disc herniation, can be yet another cause for seeking out the assistance of a disc herniation specialist. These discs are integral in helping to absorb vertebral shock, supporting the upper body, and allowing for multi-directional movement.

When a herniated disc in the neck or lower back starts to leak, the disc can quickly begin to aggravate nearby nerves and cause moderate to significant pain throughout the body. Pain due to lumbar disc herniation often occurs out of the blue for no reason at all. It often becomes apparent after participating in a grueling activity such as lifting heavy objects or even simple, everyday motions like twisting the lower back. These kinds of movements can exacerbate a slipped disc, bulging disc, or other spinal injuries.

Lumbar disc issues, similar to a herniated disc in the neck, are most common in individuals who are between the ages of 35 and 50. As people age, it’s more likely for individuals to develop a bulging disc, slipped disc, or herniation. Since discs typically lose fluid over time, they become less pliable, harder, and more prone to damage. Disc degeneration, which causes these types of changes, begins relatively early in life.

Like in the case of a herniated disc in the thoracic spine, lumbar herniations can cause a number of side effects. Since the herniation often places pressure on the spinal nerve root, the result can be intense, shooting sciatic pain in the legs and buttocks.

Fortunately, non-surgical treatment for herniated discs can often treat lumbar herniations and the symptoms rarely last longer than a month. There are three primary reasons why these types of spinal injuries and issues aren’t long-lasting: (1) The body fights against the herniation which makes it shrink in size. (2) Water from within the disc is resorbed which causes the disc to shrink and the nerves to be affected far less. (3)Specific exercises have been shown to move the herniation away from the discs themselves.

Herniated Discs Conservative Treatment – Chiropractic Consultation

Schedule a Consultation with Dr. Eingorn about Herniated Discs Conservative Treatment

Dr. Eingorn is a chiropractor who has over 25 years of experience treating patients who are dealing with neck or back injuries through the use of spinal decompression. His focus is on helping individuals who are living with herniations that require the assistance of a disc herniation specialist.

If you’ve been living in pain, it’s time to reach out for professional assistance. Herniations do not heal themselves without decompression or other similar treatments, so seeking help is a must. Dr. Eingorn takes a very thorough approach to chiropractic care and offers a number of non-surgical lumbar decompression treatments. Decompression is a proven technique that Dr. Eingorn has used to help patients who are living with a herniated disc and other similar spinal injuries and issues.

To schedule an appointment to learn more about spinal decompression and the other herniated disc treatment options available to you, give the office of Dr. Eingorn a call today at 646-553-1884.

Herniated Discs Conservative Treatment

Areas of Service

Dr. Eingorn and Better Health Chiropractic (https://betterhealthchiropracticpc.com) provide conservative treatment for disc herniations of the lower back, upper back, and neck for patients from these areas of NYC:

Manhattan, NYC, Midtown NY, Battery Park City NY, Financial District NY, TriBeCa NY, Chinatown NY, Greenwich Village NY, Little Italy NY, Lower East Side NY, NoHo NY, SoHo NY, West Village NY, Alphabet City NY, Chinatown NY, East Village NY, Lower East Side NY, Two Bridges NY, Chelsea NY, Clinton NY, Gramercy Park NY, Kips Bay NY, Murray Hill NY, Peter Cooper Village NY, Stuyvesant Town NY, Sutton Place NY, Tudor City NY, Turtle Bay NY, Waterside Plaza NY, Lincoln Square NY, Manhattan Valley NY, Upper West Side NY, Lenox Hill NY, Roosevelt Island NY, Upper East Side NY, Yorkville NY, Hamilton Heights NY, Manhattanville, Morningside Heights NY, Harlem NY, Polo Grounds NY, East Harlem NY, Randall’s Island NY, Spanish Harlem NY, Wards Island NY, Inwood NY, Washington Heights NY

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What is Conservative Treatment for a Herniated Disc?

The following article What is Conservative Treatment for a Herniated Disc? is courtesy of Better Health Chiropractic NYC Read more on: http://bit.ly/2WQ3Nlt

The term “conservative treatment” means that the treatment used to address an issue, such as a herniated disc in the lower back, is non surgical in nature and consists of other alternatives such as injections, medications, and physical therapy.

Chiropractic treatments focus on providing conservative, alternative care for neck, back, and other spinal discomfort and conditions. The majority of conservative herniated disc treatment options are used in conjunction with others in order to achieve the best possible results. The ultimate goal of non-surgical lumbar decompression and other similar treatments is to help patients alleviate their pain and experience a healthier back and spine.

In cases where non-surgical treatment for herniated discs are not advised due to immediate danger and need for emergency care, surgery may still be the necessary choice. However, in most cases, surgical intervention is only used when conservative treatments do not provide the necessary relief.

What is a Cervical Herniated Disc?

A cervical herniated disc occurs when the inner part of the disc herniates, or starts to leak outwards. This puts pressure on the surrounding nerves and occurs primarily in those between 30 and 50 years of age. While they can be caused due to injury, most occur for seemingly no reason at all.

Arm pain is a common symptom of cervical herniated discs, a symptom that is caused by pressure on the cervical nerve. Along with pain, tingling and numbness are also common as is muscle weakness.

Since the discs are in relative close contact with the nerves and not a lot of “free space” is present in the area, even the smallest herniation can cause intense pain.

What is a Thoracic Disc Herniation?

A herniated disc in the thoracic spine occurs when the inner material of a disc leaks. The result is often moderate to severe pain in the upper back as well as numbness and radiating discomfort. The type of pain experienced can vary depending upon the location of the herniation. The following are the most common symptoms experienced for:

Central disc protrusion: upper back pain (myelopathy)

Lateral disc herniation: radiating abdominal and chest wall pain

Centro-lateral disc herniation: upper back pain, radiating pain, myelopathy

Thoracic back pain can be present in a number of forms, and can be easily exacerbated when either sneezing or coughing. Pain can radiate throughout the body, especially in the chest and gut, which can make diagnosis challenging. Oftentimes, what ends up being a herniated disc in the thoracic spine is originally mistook for a heart, kidney, gastrointestinal, or lung problem.

There are many issues and disorders of the spine that can sometimes present with similar symptoms, which can make diagnosis tricky as well. These include infection, metabolic disorders, spinal fractures, and the like. This is why visiting a chiropractor can be so beneficial and can help you to determine whether the issues you’re experiencing are chiropractic in nature.

What is a Lumbar Disc Herniation?

A herniated disc in the lower back, or a lumbar disc herniation, can be yet another cause for seeking out the assistance of a disc herniation specialist. These discs are integral in helping to absorb vertebral shock, supporting the upper body, and allowing for multi-directional movement.

When a herniated disc in the neck or lower back starts to leak, the disc can quickly begin to aggravate nearby nerves and cause moderate to significant pain throughout the body. Pain due to lumbar disc herniation often occurs out of the blue for no reason at all. It often becomes apparent after participating in a grueling activity such as lifting heavy objects or even simple, everyday motions like twisting the lower back. These kinds of movements can exacerbate a slipped disc, bulging disc, or other spinal injuries.

Lumbar disc issues, similar to a herniated disc in the neck, are most common in individuals who are between the ages of 35 and 50. As people age, it’s more likely for individuals to develop a bulging disc, slipped disc, or herniation. Since discs typically lose fluid over time, they become less pliable, harder, and more prone to damage. Disc degeneration, which causes these types of changes, begins relatively early in life.

Like in the case of a herniated disc in the thoracic spine, lumbar herniations can cause a number of side effects. Since the herniation often places pressure on the spinal nerve root, the result can be intense, shooting sciatic pain in the legs and buttocks.

Fortunately, non-surgical treatment for herniated discs can often treat lumbar herniations and the symptoms rarely last longer than a month. There are three primary reasons why these types of spinal injuries and issues aren’t long-lasting: (1) The body fights against the herniation which makes it shrink in size. (2) Water from within the disc is resorbed which causes the disc to shrink and the nerves to be affected far less. (3)Specific exercises have been shown to move the herniation away from the discs themselves.

Schedule a Consultation with Dr. Eingorn about Herniated Discs Conservative Treatment

Dr. Eingorn is a chiropractor who has over 25 years of experience treating patients who are dealing with neck or back injuries through the use of spinal decompression. His focus is on helping individuals who are living with herniations that require the assistance of a disc herniation specialist.

If you’ve been living in pain, it’s time to reach out for professional assistance. Herniations do not heal themselves without decompression or other similar treatments, so seeking help is a must. Dr. Eingorn takes a very thorough approach to chiropractic care and offers a number of non-surgical lumbar decompression treatments. Decompression is a proven technique that Dr. Eingorn has used to help patients who are living with a herniated disc and other similar spinal injuries and issues.

To schedule an appointment to learn more about spinal decompression and the other herniated disc treatment options available to you, give the office of Dr. Eingorn a call today at 646-553-1884.

Herniated Discs Conservative Treatment

Areas of Service

Dr. Eingorn and Better Health Chiropractic (https://betterhealthchiropracticpc.com) provide conservative treatment for disc herniations of the lower back, upper back, and neck for patients from these areas of NYC:

Manhattan, NYC, Midtown NY, Battery Park City NY, Financial District NY, TriBeCa NY, Chinatown NY, Greenwich Village NY, Little Italy NY, Lower East Side NY, NoHo NY, SoHo NY, West Village NY, Alphabet City NY, Chinatown NY, East Village NY, Lower East Side NY, Two Bridges NY, Chelsea NY, Clinton NY, Gramercy Park NY, Kips Bay NY, Murray Hill NY, Peter Cooper Village NY, Stuyvesant Town NY, Sutton Place NY, Tudor City NY, Turtle Bay NY, Waterside Plaza NY, Lincoln Square NY, Manhattan Valley NY, Upper West Side NY, Lenox Hill NY, Roosevelt Island NY, Upper East Side NY, Yorkville NY, Hamilton Heights NY, Manhattanville, Morningside Heights NY, Harlem NY, Polo Grounds NY, East Harlem NY, Randall’s Island NY, Spanish Harlem NY, Wards Island NY, Inwood NY, Washington Heights NY

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The center region of the spine is referred to as thoracic, and while thoracic myelopathy is not common, it can happen. It usually results from fractures, spurs, or bulging discs, and the lower back as well as the middle of the back. However, you can visit a spine surgeon for thoracic myelopathy treatment in Ahmedabad.

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Effective Thoracic Myelopathy Treatment in Ahmedabad

IndoSpine Hospital offers the best thoracic myelopathy treatment, using advanced diagnostic tools and state-of-the-art surgical techniques. Our team of skilled spine specialists and neurosurgeons uses O2 O-Arm technology to deliver accurate diagnosis and excellent treatment. We provide effective medication, physical therapy, and laminoplasty using advanced lab equipment and machines. Book an appointment!

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IndoSpine Hospital is the best hospital for thoracic myelopathy treatment in India. Our spine specialists thoroughly analyse the patient’s condition and provide effective treatment including medication, physical therapy, decompression surgery or laminoplasty. Our labs are equipped with state of the art machines that help to give precise results with utmost care. Book an appointment with the thoracic myelopathy specialist today.

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Indospine Hospital provides the best thoracic myelopathy treatment in Ahmedabad. Our dedicated team of professionals gives an accurate diagnosis with the help of advanced tools & O2 O-Arm technology to deliver excellent treatment. Book an appointment today to get treatment facilities at an affordable cost!

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Best Thoracic Myelopathy Treatment In Ahmedabad

Are you looking for the best thoracic myelopathy treatment? Indospine Hospital provides highly successful treatment for thoracic myelopathy at affordable costs. Our team of skilled doctors uses advanced tools to provide the best treatment for this condition. Contact us today

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Best Spine Specialist Doctor in Rajkot

At Indospine Hospital, we take care of your spinal problem with care. Our team is led by Dr. Tarak Patel, the most trusted spine specialist in Rajkot. We have successfully treated more than 5000+ spinal severities like lower back pain, thoracic myelopathy, spondylolisthesis, spine fracture, spine infections, spine tumors, neck pain, spinal cord injury, canal stenosis, and spine deformity. Consult with our experts for the finest spine treatment.

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Highly Effective Thoracic Myelopathy Treatment in Ahmedabad

Are you looking for the best thoracic myelopathy treatment in Ahmedabad, Gujarat? At IndoSpine Hospital, we provide highly effective treatments for thoracic myelopathy. Our team of skilled spine specialists and neurosurgeons use advanced diagnostic tools and state-of-the-art surgical techniques to treat this condition. Book an appointment today.

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Spontaneous Regression of a Large Symptomatic Calcified Central Thoracic Disc Herniation: A Case Report with a Review of the Literature-Juniper publishers

Abstract

Disc herniations in the thoracic spine are rare and the incidence of symptomatic thoracic disc herniation (TDH) is 1 in a million. The incidence of asymptomatic TDH varies from 11-13%. They are classified as small (≤10%), medium (11-20%), large (21-40%), or giant (≥41%) based on the extent of canal compromise on advanced imaging. The large symptomatic calcified central TDHs are best treated operatively, as the disc fragment could be adherent to the dura or remain intra-dural [1]. We hereby report a case of one such large central calcified TDH at the T7-T8 level in a 46 year old gentleman who presented with axial mid-thoracic back pain and right-sided radicular symptoms along the intercostal nerve distribution, in addition to tingling and numbness in his lower extremities. The calcified extruded intra-dural disc fragment regressed spontaneously over two and half months, while the patient was waiting for a scheduled elective decompression surgery. The relevant MRI and CT scan images with a review of the salient literature are discussed. We believe this to be the first such case of a spontaneous regression of a large symptomatic central calcified TDH to be reported in English literature that is documented with CT and MRI scans.

Keywords: Disc herniation; Calcification; Thoracic spine; Spontaneous regression; Radiculopathy; Myelopathy

Introduction

The thoracic spine is the least common region to present with a disc herniation in comparison to cervical and lumbar regions. Majority of thoracic disc herniations (THDs) are asymptomatic and detected incidentally on magnetic resonance imaging (MRI). The incidence of asymptomatic TDH varies from 11-13% [2]. They are classified as small (≤10%), medium (11-20%), large (21-40%), or giant (≥41%) based on the extent of canal compromise on advanced imaging studies (i.e. CT and MRI) [1,3]. Thoracic disc herniations (TDHs) are rare and most commonly affect the thoraco-lumbar junction, with the T11-T12 disc being the most frequently herniated due to the greater spinal mobility and weakness of the posterior longitudinal ligament [4]. Up to 75% of thoracic disc herniations occur below the T8 vertebra, and herniation of the upper thoracic spine is very rare. A large proportion of TDHs are asymptomatic and little is known regarding the natural history of symptomatic TDHs. They affect older individuals most commonly, and a history of a precipitating event or trauma is often absent in at least half to two-thirds of the affected individuals [5]. The symptoms are secondary to chronic spinal cord compression with the calcification of an extruded fragment suggestive of co-existent degenerative changes. Younger individuals may present with a soft disc herniation and a history of acute trauma or a precipitating event that is responsive to non-operative management. Patients with a TDH may present with axial back pain, radiculopathy, and/or myelopathy with a neuro deficit. Males are more commonly affected than females, and surgery is the treatment of choice for large symptomatic calcified central TDHs [6]. The discectomy of TDHs constitutes 0.15-4% of all disc surgical procedures and the intra-operative localization of the correct surgical level is challenging [7]. A spontaneous regression of a large symptomatic calcified central TDH is rare and no case report exists to this day to the best of our knowledge in English literature. We hereby report one such case of a spontaneous resorption of a large symptomatic calcified central T7-T8 TDH in a 46 year old gentleman with relevant MRI and CT image illustrations. A review of the relevant literature with some of the proposed theories explaining such a spontaneous regressive phenomenon is also discussed.

Case Report

A 46 year old, right hand dominant academician presented with a seven month history of axial mid-thoracic back pain with discomfort and occasional radicular pain around the right hemi-thorax to the senior author’s office (MRP). The pain was associated muscle spasms on the right side of midline that warranted the intake of non-steroidal anti-inflammatory drugs (i.e. NSAIDs). He had tried a structured physical therapy program and chiropractic treatment for few months, which was marginally helpful in alleviating his symptoms. The pain was aggravated during activities that involved vibration and jarring (especially travelling), and his symptoms were partially relieved with rest and NSAIDs. Increasingly, over the recent three months, he began getting tingling and numbness in his lower extremities that initiated this consultation in our office. His Oswestry disability index (ODI) at the first clinic visit was 32%. The back pain: radicular hemi-thoracic pain ratio was 70:30 at the time of his first consultation. He denied co-existent red flag signs (i.e. bladder or bowel involvement and foot drop). His past medical history was significant for arthritis, hypertension, and type II diabetes mellitus. His past surgical history included a herniorraphy in his early twenties for an inguinal hernia. He was otherwise in good health and denied any recent history of weight loss, night pains, loss of appetite, fever with night sweats, or chills and rigors. At his most recent annual physical check-up, the assessment by his primary care physician was negative for any concerns of malignancy, hemochromatosis, hyperparathyroidism, gout, pseudogout, and hypercalcemic states. His personal history was negative for the use of tobacco products and his alcohol consumption was minimal (<3 drinks per week).

On clinical examination by the senior author (MRP), he had some midline tenderness in the mid-thoracic region over the spinous processes with a good range of motion (ROM) of both the cervical and lumbar spine. Motor strength testing revealed normal strength, tone and power (i.e., Medical Research Council [MRC] grade 5/5 motor strength) in his lower extremities. He had right-sided radiculopathy/anterior-chest band like discomfort with hemi-thoracic tenderness along the course of the T7- T9 dermatomal distribution. His right shoulder and scapular function were normal and negative for intrinsic shoulder pathology. The deep tendon reflexes in his knees and ankles were normal. The Romberg’s sign was negative, his gait was normal, and he effortlessly performed tandem-walking.

A working diagnosis of a potential space occupying lesion (SOL) in the thoracic region, causing mechanical compression of the spinal cord and/or nerve root(s), was suspected. An immediate MRI scan was arranged, which revealed a large mass causing the ventral effacement of CSF flow / signal at the T7- T8 level. His T2 weighted MRI images are illustrated in (Figure 1a & 1b). The differential diagnosis included disc herniation and other benign intra-axial neoplasms (i.e. meningioma and schwannoma). A CT scan was requested to further understand the lesion, study the extent of calcification / bony, and the intradural involvement (if any). The key CT sagittal and axial images are depicted in (Figure 2a & 2b). From these, the diagnosis narrowed down to a large central calcified TDH, following a discussion at the multi-disciplinary team (MDT) meeting.

The patient was seen at the office a week later to discuss the results of his CT and MRI scans. The natural history of disc herniation, available treatment options, risks, complications, prognosis, including watchful waiting, were extensively discussed. Surgical management, using an anterior trans-thoracic approach with a vascular co-surgeon for access, was discussed at length. A surgical discectomy with decompression was recommended and offered, given that he was persistently symptomatic with lower extremity tingling and numbness for at least three months, and because non-operative treatment failed. He chose to electively schedule the surgery in two months (seeking time off work for his post-operative recovery and making alternative arrangements for his academic/professional commitments) with an understanding that it would be undertaken immediately should there be a change in neurology and/or any bladder and bowel involvement.

He was seen in the pre-assessment clinic two weeks prior to the scheduled surgical date, reporting spontaneous improvement in his back pain and anterior-chest band like tightness, and with a resolution of his lower extremity tingling/numbness. His ODI was 4%. The proposed surgery was withheld and an interval MRI scan of his thoracic spine was requested. The T2 weighted images at two months from his initial MRI revealed the regression of the large central calcified TDH and this is illustrated in (Figure 3a & 3b). He had a complete resolution of his symptoms while waiting for surgery and he had normal neurology.He signed a written consent form and permitted us to submit and publish his clinical course of events as a case report provided he remained anonymous.

Discussion

We have reported a case of a large central calcified TDH that has spontaneously regressed over four and half months while the patient was waiting for surgical decompressive surgery. The treatment of choice for a symptomatic large central calcified TDH is operative excision by the anterior trans-throacic approach [8]. Spontaneous regressions of such central calcified discs are very rare and we believe this to be the first such reported case in English literature. The only other case report we could identify in English was a calcified right-sided foraminal T7-T8 TDH with a nucleus pulposus calcification in a 36 year old woman that regressed spontaneously over three months, as reported by Piccirilli et al. [9]. Though interestingly, our case also had the disc herniation occur at the same level (i.e. T7-T8), but it was strikingly different and unique in several aspects, in that our case had

A large central calcified TDH,

The absence of nucleous pulposus calcification, and

A decade older male patient (46 year old gentleman vs. 36 year old woman).

The pathogenesis of this rare phenomenon of spontaneous resorption is poorly understood. Proposed theories postulated to explain it include [10-12]:

Dehydration of the herniated fragment and its subsequent resorption,

Activation of the inflammatory process leading to degradation and resorption,

Re-accommodation of the nucleus pulposus in the inter vertebral disc space, or

The bathing of extruded disc material in epidural space by blood vessels, which facilitate neovascularisation and eventual macrophage infiltration with phagocytosis.

The clinical course of a TDH is variable, and a patient can present with non-spinal symptoms and an atypical pain pattern mimicking other organ system involvement to frank myelopathy. Though the spinal cord is smallest in diameter in the thoracic region, the cord: canal ratio is at least 40% compared to 25% in the cervical region, which make sit sensitive to compressive effects [4]. Varying degrees of myelo-radiculopathy, Brownsequard syndrome to paraplegia are reported with symptomatic TDHs [13]. The incidence of bladder and/or bowel involvement in TDHs varies from 15-20%. A high degree of clinical suspicion, supplemented by a thorough history, physical examination, and confirmation by the appropriate diagnostic imaging, is essential for accurate diagnosis.

Calcification of inter vertebral discs could potentially occur at three places:

The annulus fibrosus,

The fibro cartilaginous plate, and

Centrally in the nucleus pulposus.

Von Lushka was the first to describe this phenomenon in adults and observed such calcifications, especially in the annulus fibrosus, to be almost always asymptomatic [14]. The calcification of the nucleus pulposus is secondary to the deposition of amorphous calcium salts in degenerated tissue and might regress spontaneously, especially in children. Disc calcification also correlated significantly with the morphologic degree of degeneration. CT myelography is considered to be the investigation of choice for the evaluation of calcified TDHs, as it demonstrates the degree of canal encroachment / intra-dural extension better than other imaging modalities [15].

Giant TDHs occupy at least 40% of the canal dimensions and were first defined by Hott et al. [3]. They produced severe neurological deficit and were associated with poor functional outcome compared to small and medium TDHs. The authors recommended open thoracotomy, rather than thoracoscopy, in treating such giant calcified TDHs. Barbanera et al. [16] reported a series of 7 patients who had symptomatic giant calcified TDHs and none of them regressed spontaneously. Brown et al. [17] evaluated 55 patients with symptomatic TDHs and observed only 15 patients needed surgery (27%). Encouraged by those findings, they recommended a less aggressive surgical approach, as TDHs did not necessarily cause severe neurological compromise. Wood et al. [2] studied the natural history of asymptomatic TDHs and recommended mere observation to be justifiable, even in symptomatic individuals whose chief complaint was axial spinal pain. Outside of English literature, we identified only four cases (three publications) of a spontaneous resorption of a TDH in the French and Italian languages.

Coevoet et al. [18] reported a case of a T9-T10 protrusion that regressed spontaneously over 13 months. Martinez-Quinone et al. [19] reported a case of a T6-T7 TDH in a 47 year old male that regressed spontaneously. Neither of the two reports specified if those discs were calcified. Eap et al. [20] reported two cases of a spontaneous resorption of a calcified TDH. They included a left T8-T9 foraminal herniation in a 48 year old and a large central T12-L1 herniation (similar to our case) in a 45 year oldpatient.

Komori et al. [21] observed extensive rim enhancement on follow-up MRI imaging to be predictive of spontaneous resorption. A gadolinium enhanced diethylenetriaminepentaacetic acid (Gd- DTPA) MRI could be used to evaluate the neovascularisation zone and might give an insight into the dynamics of disc resorption. Auito et al. [22] studied the determinants of spontaneous resorption in lumbar disc herniation by longitudinal Gd-DTPA enhanced MRI scans, focusing on the rim enhancement zone, and they observed that a higher rim enhancement thickness, a higher degree of HNP displacement, and the age group of 41-50 years to be associated with better resorption rate. The clinical symptom alleviation correlated well with the rate of disc resorption, and dramatic clinical improvement was seen at the end of two months. Unfortunately no such studies have been reported until now for TDHs.

Conclusion

In summary, a large symptomatic calcified central TDH can be treated with careful observation, as long as the patients are capable of coping with the pain and do not have any lower extremity motor weakness or other red flag signs. A better understanding of pathomechanisms that attempt to further elucidate the complex interplay between disc calcification, disc angiogenesis, and disc degeneration is desired, so that strategies are developed to predict disc herniations that regress spontaneously. Studies focusing on investigating such link mechanisms are desired and constitute grounds for further research. Such studies might also explain which TDHs would most likely regress on their own and define the role of surgery vs. non-operative treatment in the management of symptomatic large central calcified TDHs.

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