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ABSTRACT

This article describes an atypical clinical case involving an obese patient with multiple thoracic disc herniations associated with progressive neurological impairment. The patient, a 46-year-old man, presented with severe chest and low back pain radiating to the lower limbs, with a history of treatment failure with conservative approaches and progressive functional deterioration. Magnetic resonance imaging of the thoracic spine revealed three compressive lesions at the T2-T3, T4-T5, and T5-T6 levels, with signs of spinal cord myelopathy. A minimally invasive endoscopic surgical approach was chosen. During the procedure, loss of intraoperative evoked motor potentials was observed, leading to the interruption of the surgery and the scheduling of a second stage to complete decompression. Despite the two-stage surgical intervention, there was no significant clinical recovery. The patient developed severe systemic complications, including nosocomial pneumonia, which culminated in death. Totally endoscopic techniques have established themselves as viable alternatives in high-risk surgical patients, such as those with severe obesity, as they offer lower morbidity and potentially reduce perioperative complications. However, this report highlights that, even with the use of advanced techniques, multifactorial factors can compromise the clinical outcome, highlighting the complexity of neurosurgical management in high-severity cases. .

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