“Discal bullet syndrome”: A sudden spinal cord compression by disc herniation expulsion

Abstract

Background and importance: The intramedullary disc herniation’s remain more exceptional and highlight the difficulty diagnosis as well as the surgical approach. Clinical presentation: A 74-year-old woman with obesity history presented an acute spinal cord compression syndrome consecutive to a violent thoracic back pain, described like a “shot gun”. Spine magnetic resonance imaging (MRI) revealed a solitary non-specific intramedullary lesion (T10-T11 level). Surgery was performed and revealed multiple fragments of degenerative disc and resected from the spinal cord under pressure. At 6-month follow-up with rehabilitation showed incomplete recovery of paraplegia. Conclusion: The sudden paraplegia associated with violent back mimicking a ballistic trauma, which we named as the “discal bullet syndrome”, could be favoured by local weaknesses in the dura/ligamentum, or perhaps by obesity. The functional prognosis of this entity remains poor.

Keywords

• Herniated nucleus pulposus
• Thoracic spinal cord compression
• Intramedullary spinal cord lesion