Abstract

Thoracic disc herniations (TDH) requiring surgery are rare. They usually present with pain and/or myelopathy. Only 6% are wide lateral, either intraforaminal or extraforaminal. A 52-year-old patient presented with chronic mid-thoracic pain, radiating along the left 9th and 10th ribs. After nephrologic and pancreatic diseases had been excluded, a CT-scan showed a far-lateral calcified TDH in the left Th9-Th10 neuroforamen, compressing the nerve root. Through a paramedian muscle-splitting approach, microscopic drilling of the medial part of the Th9-Th10 facet joint was performed, allowing exposure of the nerve root and removal of a soft hernia, a mix of degenerative debris and harder calcified aggregates. Postoperatively, the pain disappeared immediately. The authors conclude that intraforaminal TDH may be misleading and mimick pain from abdominal origin. Even if calcified, these lesions may be soft, not adherent and thus easily resectable : this may allow a simpler approach. A microscopic transfacet route offers a minimally invasive approach to the neuroforamen.