Sacral insufficiency fracture: a single-center experience of 185 patients with a minimum 5-year follow-up.

PURPOSE: Sacral insufficiency fracture (SIF) is a commonly underdiagnosed etiology of back pain, especially in the geriatric and osteoporotic population. In this clinical study, we present our experience of 185 patients who were diagnosed with SIF and managed either with conservative or surgical treatment with a minimum 5-year follow-up. MATERIALS AND METHOD: Patients who were diagnosed with SIF, managed either conservatively or surgically, and had a minimum 5-year follow-up medical record were included in this study. CT scans and MR imaging including coronal STIR sequence were obtained from all. Bone densitometry (DEXA) was performed to detect accompanying osteopenia or osteoporosis. Patients were treated either conservatively or surgically. VAS and ODI scores were evaluated prior to the treatment and 1st day, 10th day, 3rd month, and 1st year postoperatively. RESULTS: The mean age of 185 patients was 69.2 and the mean follow-up period was 7.23 years (range: 5-11 years). 46 (24.9%) patients had a previous spinal or spinopelvic surgery and spinal instrumentation was implemented in 22(11.89%) of them. The time interval between the fusion surgery and the diagnosis of SIF was approximately 9.48 weeks. The fracture line could be detected with the MRI in 164 patients and with the CT in 177 patients. The fracture was bilateral in 120 (64.8%) patients. 102 patients were treated conservatively, and 83 received sacroplasty. VAS and ODI scores showed better improvement in pain and functionality in the surgical management group than in the conservative management group. CONCLUSION: SIF should be considered in the differential diagnosis of back and pelvic pain, especially in elderly and osteoporotic patients. MRI with coronal STIR imaging should be a standard protocol for patients with a risk of SIF. Our results show that sacroplasty provides better and faster pain relief and recovery than conservative management.

"Skip" corpectomy technique in multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament: Outcomes with over 10-years follow-up.

OBJECTIVE: Skip corpectomy is a surgical technique that includes C4 and C6 corpectomies and fusion via autografts and a cervical plate and is frequently performed in patients with CSM and OPLL. This study presents long-term clinical and radiological outcomes of 48 patients who underwent skip corpectomy with 10-year follow-up. METHODS: 48 patients who were diagnosed with CSM or OPLL were included. All patients underwent spinal canal decompression and fusion via skip corpectomy. Clinical assessment was performed using the JOA scoring system. The radiological assessment was performed using plain anteroposterior, lateral, and flexion-extension cervical spine radiographs; cervical spine MR imaging; and cervical spine CT scans. The spinal canal size, spinal cord occupation ratio, cervical lordosis, and T2 signal changes were evaluated preoperatively, and postoperatively. RESULTS: The mean follow-up period was 14.6 years (13-20 years). Preoperatively, the JOA score was 11.06 ± 3.09. The mean cervical lordosis was 2.08°±11.74 and the average SCOR was 62.1 ± 14.22. There was a significant improvement in SCOR in the early postoperative period. The average cervical lordosis increased to 13.81 ± 2.51 in the 2nd month and minimal loss of cervical lordosis was observed on the 10th year in two patients. Fusion was achieved in all patients, regardless of the graft type. None of the patients had implant failure and graft or hardware-related complications at the 10th-year follow-up. CONCLUSION: Skip corpectomy provides efficient decompression of the spinal cord and provides adequate sagittal alignment and fusion in patients with CSM and OPLL. Long-term radiological and clinical outcomes of the technique are favorable.

Three region spinal decompression in the same session: a case report.

BACKGROUND AND IMPORTANCE: Multiregional spinal stenosis [tandem spinal stenosis (TSS)] is not rare but operating on multiple regions at the same sitting is. Decompression of cervical and lumbar spine in the same session has a frequency of 5-25% all TSS cases, the most frequent one is TSS. Decompression in three different regions is so rare that there is only one case in the literature. We report the second. CLINICAL PRESENTATION: A 72-year-old man with pain in legs and arms, neurogenic claudication, progressive loss of balance, radiculopathy and myelopathy in lower and upper extremities whose cervical-thoracic and lumbar spinal stenosis were treated with decompressive surgery in the same session. Total time of surgery for three regions was 330 min. No complications were observed. The patient was mobilized on day 1 postoperative and was discharged from the hospital on day 3. By month 3, motor function had improved almost completely, and pyramidal findings have decreased. CONCLUSION: Multiregional spinal stenosis of three spinal regions at the same time is a rare case and these cases, surgery of three regions can be carried out in the same session respectively.

Radiological and clinical comparisons of the patients with rheumatoid arthritis operated with rigid and dynamic instrumentation systems due to lumbar degenerative spinal diseases.

BACKGROUND: It is extremely difficult to treat spine disorders with stabilization in patients with rheumatoid arthritis. Because revision rates are significantly higher in rigid stabilization. To date, there is no data about patients with rheumatoid arthritis treated with dynamic stabilization. Our aim was to compare the radiological and clinical results of patients with rheumatoid arthritis who underwent lumbar rigid stabilization or dynamic stabilization with Polyetheretherketone rod (PEEK). METHODS: Patients with degenerative lumbar spine disease with rheumatoid arthritis who underwent dynamic stabilization between 2013 and 2015 and rigid stabilization between 2010 and 2012 were evaluated radiologically for adjacent segment disease, proximal junctional kyphosis, system problem (nonunion, screw loosening, instrumentation failure, pull out). It was also compared according to both the revision rates and the Visual Analog Scale and Oswestry Disability Index scores at the 12th month and 24th month. RESULTS: The difference of decrease in Visual Analog Scale and Oswestry Disability Index scores from preoperative to 12th month between patients who underwent dynamic stabilization and rigid stabilization was statistically insignificant. However, there was a significant difference of increase in Visual Analog Scale and Oswestry Disability Index scores between the 12th month and 24th month of patients who underwent rigid stabilization, compared with patients with dynamic stabilization. In patients with dynamic stabilization, the problems of instrumentation were seen less frequently. Revision rates were high in patients with rigid stabilization when compared the patients with dynamic stabilization. CONCLUSION: Radiological and clinical outcomes in patients with rheumatoid arthritis operated with dynamic stabilization are more significant when compared to rigid stabilization. These patients have lower pain and disability scores in their follow up periods. Revision rates are lower in patients with dynamic stabilization.

Traumatic basal ganglia hematoma following closed head injuries in children.

PURPOSE: High-velocity trauma with acceleration/deceleration forces turns into shear stress over lenticulostriate or anterior choroidal arteries that lead to basal ganglia hemorrhage. Traumatic basal ganglia hematoma has rarely been described in pediatric population. The aim of this study was to present our clinical series of pediatric patients with traumatic basal ganglia hematoma and to analyze the prognostic indicators of traumatic basal ganglia hematoma. METHODS: In this retrospective case series, emergency admissions of pediatric patients with traumatic basal ganglia hematoma due to closed head injury were analyzed. Demographic, clinical, and radiographical data of the patients were retrieved from patients' charts and picture archiving and communication system. RESULTS: There were four children with traumatic basal ganglia hematoma (TBGH). All patients were male. Median age was 8 years (range = 7-16 years). Road accident (three) and fall (one) were the causes of the traumas. Basal ganglia hematoma was present on the right side in one patient and on the left side in three patients. Hematoma volumes ranged from 0.9 to 8.94 ml. All patients were treated conservatively. One patient recovered fully; two patients were moderately disabled at their last clinical follow-ups. The last patient with diffuse subarachnoidal hemorrhage and edema died despite all interventions. CONCLUSIONS: Traumatic basal ganglia hematomas are unique and different from other kind of intracerebral hematomas. The eloquent nature of basal ganglia makes it more vulnerable to head trauma. Mechanism of injury, energy and velocity of injury are the most important prognostic criteria. Post-traumatic phase of injury should be carefully observed in patients with TBGH, especially when mechanism and velocity of injury are severe and high.

Pandora's box: eosinophilic granuloma at the cerebellopontine angle-should we open it?

BACKGROUND: Langerhans cell histiocytosis (LCH) is a disorder of immature LCH cells, eosinophils, macrophages, lymphocytes, and multinucleated giant cells. Eosinophilic granuloma (EG) is a focal form of LCH that presents mostly in the skull, femur, vertebrae, pelvis, mandible, and ribs. Intracranial presentation of EG is very rare in the literature. CASE DESCRIPTION: A 17-year-old boy visited our clinic with headache, dizziness, and tinnitus that were present for 2 months. Brain MRI depicted a lesion at the right cerebellopontine angle. The lesion was hypointense on T1-weighted and hyperintense on T2-weighted brain MR images. The lesion enhanced homogenously after I.V. contrast material administration. Pre-operative diagnoses were vestibular schwannoma and meningioma. Surgery was planned. Retrosigmoid approach was preferred in the surgery. The lesion was excised partially. Pathological analysis depicted cell infiltration composed of eosinophils besides histiocytes, plasma cells, and lymphocytes in different amounts. CD1a was positive yet S100 was negative. Final diagnosis was eosinophilic granuloma. Post-operative course was uneventful. The patient was referred to pediatric oncology unit, and steroid therapy was initiated. Post-operative follow-up brain MRIs showed that the lesion had regressed further than immediate post-operative images by only steroid use. In long-term follow-up, new lesions appeared on the patient's skin in multiple locations and in the sclera of his left eye. At the last follow-up (3 years post-operatively) skin and scleral lesions were noticed to have regressed spontaneously and the intracranial structures were tumor free. DISCUSSION AND CONCLUSION: To the best of our knowledge, EG at the cerebellopontine angle has not been presented in the literature. What makes our case further unique is its negativity for S-100 antigen. Eosinophilic granuloma should be kept in differential diagnosis of mass lesions presented at the cerebellopontine angle, especially in children and young adults with high eosinophils and lymphocytes in their peripheral blood. Sole steroid trials could be conveyed in suspicious cases before any further intervention. If the lesions do not regress or enlarge with time, surgery should be considered. However, long-term follow-up of these patients is necessary since natural history of the disease has not been defined, yet.

Spontaneous third ventriculostomy 8 years after diagnosis of obstructive hydrocephalus.

BACKGROUND: Spontaneous ventriculostomy is spontaneous rupture of membranes separating the ventricular system from the subarachnoid space in patients with chronic obstructive hydrocephalus that ends with resolution of symptoms. We present a case of spontaneous third ventriculostomy occurred in a 19-year-old girl 8 years after the initial diagnosis of hydrocephalus. CASE DESCRIPTION: An 11-year-old girl applied to the clinic with intermittent headaches. She was neurologically stable with no visual problems. On her brain MRI, obstructive hydrocephalus was observed. Cerebrospinal fluid diversion procedures were recommended, yet the family denied any interventional procedure. She had routine follow-ups with occasional clinical admissions because of ongoing intermittent headaches. On her last clinical visit, 8 years after the first one, she was in well condition with improvement in her headache in the last 4 months. Her new brain MRI showed an active CSF flow between the basal cistern and the third ventricle. DISCUSSION AND CONCLUSION: In patients with aqueductal stenosis and without any other mass lesion, wait and see protocol might be conveyed in case of mild symptoms of hydrocephalus. However, there is need for large-scaled studies to make a more comprehensive statement for benign obstructive hydrocephalus cases.

From idea to publication: Publication rates of theses in neurosurgery from Turkey.

OBJECTIVES: Thesis at the end of residency is considered as the complementary component of postgraduate training. In this respect, thesis helps the residents learn how to ask structured questions, set up the most appropriate study design, conduct the study, retrieve study results and write conclusions with clinical implications. To the best of our knowledge, the publication rates of theses in the field of neurosurgery have not been reported before. Our aim was to find out publication rates of theses in neurosurgery specialty, in this descriptive study. METHODS: The database of Higher Education Council of Turkey, which includes the theses of residents in only university hospitals, was screened between years 2004 and 2013. After retrieving the theses from the database; we used search engines to find out the theses published in any SCI/SCI-E-indexed journals. For this purpose, the title of the theses and the author names were used as keywords for searching. Data was presented in a descriptive form as absolute numbers and percentages. RESULTS: We retrieved 164 theses written by former residents in neurosurgery using the database. Among 164 theses, 18% (national journals: 9; international journals: 21) were published in SCI/SCI-E indexed journals. CONCLUSION: Publication rates of theses in neurosurgery are low as they are in the other specialties of medicine. Our study is a descriptive research, to give an idea about publication rates of theses in neurosurgery. Further studies are required to understand the underlying factors, which are responsible for the limited success in publication of theses in neurosurgery.

Spontaneous rapid resolution of acute subdural hematoma in children.

BACKGROUND: Spontaneous rapid resolution of acute subdural hematoma developing secondary to trauma has been reported in the literature, yet it is very rare in pediatric population. The aim of the present review is to analyze mechanisms, characteristics, and outcomes of pediatric acute subdural hematoma cases with spontaneous rapid resolution in conjunction with an exemplary case of ours. CASE DESCRIPTION: A 3-year-old boy was admitted to our emergency department following mild head trauma secondary to a fall from 2 m. He was alert and has a GCS of 15. He had no motor or sensorial deficit on neurological examination. On the emergent brain computed tomography image, an acute subdural hematoma over left frontoparietal lobe was observed. There was a midline shift of 8.3 mm and the width of the hematoma at the thickest portion was 11.2 mm. Surgery was postponed with a close neurological follow-up of the patient in pediatric intensive care unit, due to his well neurological status without any increased ICP findings. On the fourth hour follow-up head CT image, amount of midline shift and hematoma thickness were observed to have regressed dramatically. At the second week, the hematoma resorbed totally with only conservative approach, and he was discharged to home in well status. DISCUSSION AND CONCLUSION: Analysis of 12 pediatric patients revealed a mean and median ages of 6.87 and 3.9 years, respectively (range = 8 months-18 years). Causes for ASH development were fall, traffic accident, struggle, and child abuse. Main clinical presentations were with depressed sensorium, coma, stupor, drowsiness, headache, motor weakness, lethargy, and seizure. Close follow-up with conservative treatment should be mode of approach in pediatric patients with ASH, if neurological and radiological findings are favorable. However, if patients' neurological status deteriorates after admission to hospital, surgery should be conveyed with no further delay.

Circumferential Approach to Congenital Kyphoscoliosis with Hemivertebra: Adding on Rather than Resecting Could Be a Better Option in Older Adolescents.

OBJECTIVE: To present a new technique combining anterior release with allograft insertion and lateral fixation at the concave side of the curve, preserving the hemivertebra and posterior bilateral transpedicular fixation in patients with congenital kyphoscoliosis (CKS) who were not operated on until late adolescence, including long-term follow-up of patients, and a discussion of the literature on CKS with hemivertebra. METHODS: Two patients with CKS concomitant with hemivertebra underwent circumferential (anterior-posterior) instrumentation and fusion using a new technique. RESULTS: Patient 1 underwent a 2-stage operation, first anterior then posterior. Patient 2 was operated on circumferentially in 1 session. Both patients had >10 years of follow-up showing solid fusion of their operated spine segments. The patients were pain-free, and their body heights were comparable to healthy peers. CONCLUSIONS: In our circumferential approach, we successfully integrated the hemivertebrae in anterior fusions rather than resecting them in older adolescents with CKS. This technique decreased bleeding, shortened operative time, and promised potential benefits compared with the available techniques in the literature.

The relationship between bone canal diameter and facet tropism in cases of lumbar spinal stenosis.

Objectives: Lumbar spinal stenosis (LSS) is a condition that increases in frequency with the aging of the spine and has adverse effects on the quality of life of individuals. Facet tropism (FT) refers to the difference in the orientation of the facet joints relative to each other in the sagittal plane. This situation may be due to a developmental defect or different stimuli. In many biomechanical studies in the literature, the relationship between FT and lumbar degenerative disorders has been investigated. In this study, we aimed to investigate whether there is a relationship between anteroposterior bone canal diameter and FT in LSS cases. Materials and Methods: We retrospectively evaluated the CT and T2-weighted axial and sagittal magnetic resonance imaging of the lumbar region of 100 LSS patients who were operated on in our clinic between 2015 and 2017. For each patient, the facet joint angles, the degree of FT, and the AP diameter of the spinal canal were determined. Results: The cases were grouped according to FT types and no correlation was found between midsagittal bone spinal canal measurement and FT types. According to the results, no significant difference was found. Conclusion: As a result, because of there is no relationship between midsagittal bone canal diameter and FT, we thought that FT may be both a part of the degenerative process and a congenital origin.

Vertebroplasty with Decompression for Epidural Extending Vertebral Hemangiomas: An Alternative Technique.

AIM: To document the effectiveness of an alternative surgical technique with concurrent vertebroplasty and decompression without instrumentation for patients with vertebral hemangioma presenting with neural compression symptoms. MATERIAL AND METHODS: This study is a technical note and a retrospective clinical evaluation. We analyzed the data of 8 patients operated with our alternative surgical technique for vertebral hemangiomas with epidural extension and neural compression, between 2013 and 2018. The preoperative, postoperative 1st month and postoperative 12th-month Visual Analogue Scale (VAS) scores were assessed and compared. RESULTS: Five of the patients had lumbar and 3 had thoracic hemangiomas. The difference between preoperative and 1st and 12thmonth Visual Analogue Scale scores were statistically significant. None of the patients received additional intervention, stabilization, or needed a blood transfusion. CONCLUSION: This technique is a safe and minimally invasive approach for vertebral hemangiomas with epidural extension allowing decompression of the spinal cord without massive hemorrhage.

Any Instrument in a Surgeon's Hand can be Fatal: Unusual Iliac Artery Injury in Lumbar Spinal Deformity Surgery.

BACKGROUND: Vascular complications, which we rarely encounter during lumbosacral stabilization surgeries, can be life-threatening if they are not treated quickly. These arterial injuries occur during screw insertion. Our presentation with the common iliac artery injury during the decortication process in transverse processes with the "pedicle awl" will be the first case in the literature to our knowledge. CASE DESCRIPTION: Lumbosacral decompression and stabilization surgery was performed in a 57-year-old patient with L1-S1 spinal stenosis and scoliosis. After the stabilization process was completed, while decorticating the transverse processes with the pedicle awl, the tool fell to the paravertebral region, and then active arterial hemorrhage was observed at the surgical site. Hemostasis was achieved in the surgical field, but a rapid progressive drop was observed in the patient's blood pressure. The surgery was quickly terminated, and the patient was turned to the supine position. Vascular surgeons opened the abdomen with a midline laparotomy, and approximately 2600 mL hematoma was evacuated from the retroperitoneum. The 5-mm defect in the left common iliac artery was repaired by primary suturing. The patient had no problem in postoperative follow-up and was discharged on the 10th postoperative day. CONCLUSIONS: In these complications that we rarely encounter in lumbosacral stabilization surgeries, perioperative findings should be well evaluated, and rapid intervention should be made in cases in which vascular injury is considered. One must remember that every tool used during surgery can be dangerous even in an experienced hand.

Acute spinal epidural hematoma: A case report and review of the literature.

Spinal epidural hematoma (SEH) is a rare but a significant cause of spinal cord compression and neurologic deficits. Its etiology is usually unknown and requires emergency intervention. The present study aims to review the clinical significance, treatment strategies and clinical outcomes of traumatic SEH with a rare case presentation. Our patient was a 42-year-old female who presented with back pain and loss of sensation and strength in the legs. The patient did not have any disease and did not use anticoagulant drugs. The patient developed numbness in her legs half an hour after having a traditional back walking massage due to occasional back pain. She was paraplegic and anesthetic when seen in our clinic. Thoracic computed tomography (CT) and magnetic resonance imaging (MRI) revealed posterior epidural hemorrhage at Th3-Th4 levels. In the 12th hour, the hematoma was evacuated by an emergency decompressive hemilaminectomy. At the postoperative 24th hour, the patient had symptomatic improvement, and in the sixth month, the patient was mobilized with support. SEH is a rare condition that should be considered in patients with sudden onset of back pain and extremity weakness. Although the gold standard diagnostic tool is MRI, CT is often sufficient to avoid delayed surgery. Immediate surgical decompression (laminectomy/hemilaminectomy) should be performed in cases diagnosed with SEH with neurological deficits.

Polymethylmetacrylate Cement Augmentation of the Coccyx (Coccygeoplasty) for Fracture: A Case Report

Background: Coccydynia is a painful condition of the sacrococcygeal region, with symptoms associated with sitting and rising from a seated position. It is frequently related to trauma and idiopathic causes, and the pain is mostly chronic. Percutaneous vertebroplasty and sacroplasty are the methods that are widely used for treating compression fractures and sacral insufficiency fractures, respectively. However, the success of polymethylmethacrylate injection in the treatment of osteoporotic coccyx fractures and coccydynia is still unknown. Case Report: A 68-year-old man was admitted to our clinic with complaints of pain in the sacrococcygeal and perianal regions. In the imaging studies, a fracture line in the fifth sacral and first coccygeal segments was observed as evidenced by a bony edema. Since the patient's pain did not improve with conservative methods, we treated him with coccygeoplasty. No complication was encountered. The day after the operation, he was discharged from the hospital with complete pain relief. The patient confirmed having no pain on the third postoperative month and so did not need any analgesics. Conclusion: Coccyceoplasty may be a good treatment option for retractable pain in patients with acute or subacute osteoporotic coccygeal fractures and coccydinia with edema.

Clinical and radiological outcomes after correction of degenerative lumbar scoliosis with dynamic stabilization (with the help of a rigid rod); and describing an alternative technique.

Sharing clinical and radiological results in patients with degenerative lumbar scoliosis (DLS) treated surgically with dynamic system and describing an alternative technique for scoliosis correction. Between 2013 and 2018, 48 patients with flexible degenerative lumbar scoliosis (DLS) were operated with dynamic stabilization with Polyetheretherketone Rod (PEEK rod) after rigid rod application. Preoperative and postoperative scoliosis angles (standing and supine) were statistically compared. Preoperative and postoperative low back pain (LBP) Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were compared. In addition, preoperative C7 Sagittal Vertical Axis (SVA) values and lumbar lordosis angles were compared with postoperative values. The mean follow-up period of the patients was 48.3 months (range 30-76), the mean age was 67.08 (range 49-84). While the average Cobb angle of all patients was 9.65 in preoperative supine position, the average Cobb angle with standing position was 19.73. The mean standing Cobb angle of the patients after surgery was 3.52. The mean Cobb angle in the supine position after surgery was 3.02. The difference between the preoperative and postoperative patients' Cobb angles in standing and supine position were statistically significant (p:0,000, p:0,000, respectively). The differences of VAS and ODI scores between preoperative and postoperative period were statistically significantly (p:0,000, p:0,000; respectively). Especially in patients with flexible LDS, the technique we have defined and dynamic stabilization with PEEK rod provides significant correction. There was no loss of correction in our patients during postoperative follow-up period. PEEK rod is insufficient for lordosis increase and correction of SVA values.

Spinal anesthesia in surgical treatment of lumbar spine tumors.

OBJECTIVE: This study aims to show the feasibility of spinal anesthesia in lumbar spinal tumor surgery; share our data and experience. PATIENTS AND METHODS: A retrospective review of 14 patients with high risk for general anesthesia due to severe comorbidities was carried out. Patients who underwent surgeries under spinal anesthesia for lumbar vertebral column or spinal cord tumors at a single center between 2007-2019 were evaluated. The final pathological diagnosis, operation time, and surgical procedures were analyzed. Also, preoperative and postoperative advantages and disadvantages were determined. A comparison was performed with other 184 patients who were operated for spinal tumors in the same period under general anesthesia. RESULTS: Maximum operation time was found 220 min, and the average operation time was 166 min. The most primary diagnosis was vertebral column metastasis. The mean age was 65.5 years. None of the patients required general anesthesia during surgery; however, two patients needed additional spinal anesthesia preoperatively, which was performed by the surgeon. Lumbar decompression and fusion were the most performed procedures. CONCLUSION: Spinal anesthesia is a feasible and useful method of anesthesia in lumbar spinal tumor surgery for especially elderly patients with American Society of Anesthesiologists (ASA) 3 or 4 score and high risk of general anesthesia.

Phantom Radicular Pain Treated with Lumbar Microdiscectomy: A Case Report.

Phantom limb pain in amputee patients is not well defined in the literature. Also, there is still no clear information on the definition and treatment of phantom radicular pain, in which amputee patients have radicular pain. This phenomenon, called phantom radiculitis or phantom radiculopathy, has been described in a limited number of cases. If a pathological condition that may cause radicular pain is present in amputee patients, the severity of phantom pain increases. Degenerative disc disease is the most common cause of phantom radicular pain. Spinal injection can be used to control this pain. Surgical treatment can be performed when adequate pain control cannot be achieved. The phantom radicular pain of the patient is expected to improve after surgical or medical treatment. The pain is expected to descend to previous levels if phantom pain was present previously. In this paper, we present and discuss a case of phantom radicular pain in the context of treatment with lumbar microdiscectomy.

Traumatic Sequestrated Thoracic Disc Herniation; A Case Report.

AIM: To present a case (3rd report in the literature, 1st case with sequestrated-extruded disc herniation) of thoracic disc herniation that was sequestrated only by ligamentous injury without thoracic osseous pathology. MATERIAL AND METHODS: We reviewed the diagnosis and treatment of a 25-year-old man presenting with paraplegia after a car accident. RESULTS: In this case, no pathology was seen on the X-ray and spinal computed tomography (CT), and the paraplegia of the patient was unexplained in the first examination. Subsequent spinal MRI revealed a T12-L1 cranial-migrated soft disc herniation, which was surgically treated and neurologically recovered within weeks after surgery. CONCLUSION: Traumatic thoracic disc herniations are extremely rare and can be seen without any obvious signs of trauma on X-ray and spinal CT. A spinal MRI scan helps with diagnosis, while rapid surgical treatment (decompression) supports excellent recovery.