Bilateral Multiple Thoracic Disc Herniation Decompressed Through a Posterior Transpedicle Approach: A Case Report.

A four-level thoracic disc prolapse is extremely rare, especially when surgical intervention is required. The level of the disc and the herniation's direction determine the surgical approach of selection. A 46-year-old male presented with a two-week history of severe, sudden back pain and weakness in his lower extremities. Clinical presentation was suggestive of thoracic radiculopathy and myelopathy. Magnetic resonance imaging confirmed four-level disc prolapses at the levels of T9-T10, T10-T11, and T11-T12, which were central and in both directions. Decompression and fixation were done through the posterior transpedicular approach. The surgical approaches for decompression of multiple thoracic disc herniations are not commonly discussed in the literature due to their rarity. Generally, the anterior trans-thoracic approach is preferred over the posterior approach for one or two-level herniation. The posterior transpedicular approach was chosen in this case because it is less invasive and avoids combined approaches. Also, the herniated discs were in four consecutive levels, and the herniations were in different directions. In cases of multiple thoracic disc herniations requiring surgery, the posterior transpedicular approach allows access to the discs from both the right and left sides, enabling safe and complete decompression while avoiding more invasive or combined approaches.