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High Thoracic Disc Herniation Causing Horner Syndrome with the Intraoperative Finding of Conjoined Nerve Root Compression

A Case Report

Bhandutia, Amit K., MD1,a; Zuzek, Zachary, BS2; Schessler, Matthew J., MD1; Tomycz, Nestor D., MD1; Altman, Daniel T., MD1

doi: 10.2106/JBJS.CC.16.00106
Case Reports

Case: A 29-year-old man presented with right medial arm pain with paresthesia, as well as right-sided ptosis, miosis, and anhidrosis. Magnetic resonance imaging revealed a right paracentral disc herniation at the T1-T2 level. The patient underwent a hemilaminectomy with a medial facetectomy through a posterolateral approach to the T1-T2 disc space, followed by a discectomy. Intraoperative findings were notable for a conjoined nerve root.

Conclusion: Although high thoracic disc herniation is rare, its diagnosis should be considered when patients present with radicular arm pain and Horner syndrome. A high index of suspicion should be maintained for nerve root anomalies to limit iatrogenic injury and to ensure successful decompression.

1Departments of Orthopaedic Surgery (A.K.B., M.J.S., and D.T.A.) and Neurosurgery (N.D.T.), Allegheny General Hospital, Pittsburgh, Pennsylvania

2Drexel University College of Medicine, Philadelphia, Pennsylvania

aE-mail address for A.K. Bhandutia:

Copyright © 2017 by The Journal of Bone and Joint Surgery, Incorporated
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