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Thoracic Disk Disease: Diagnosis and Treatment

Dr. Vanichkachorn is Chief Resident, Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia. Dr. Vaccaro is Professor of Orthopaedics, Thomas Jefferson University Hospital.

Reprint requests: Dr. Vaccaro, Fifth Floor, 925 Chestnut Street, Philadelphia, PA 19106.

Symptomatic degenerative disk disease is much less common in the thoracic spine than in the cervical and lumbar regions. Accurate diagnosis relies on a strong clinical suspicion that is confirmed with appropriate diagnostic imaging. Presenting symptoms vary tremendously, from atypical pain patterns to myelopathy. The use of computed tomography in combination with myelography and magnetic resonance imaging have greatly increased the ability to accurately visualize thoracic spine disorders. The superior resolution of available imaging modalities has made the incidental detection of asymptomatic thoracic disk abnormalities more frequent. Most patients with symptomatic thoracic disk disease will respond favorably to nonoperative management. Surgery is indicated for the rare patient with an acute thoracic disk herniation with progressive neurologic deficit (i.e., signs or symptoms of thoracic spinal cord myelopathy). Once surgical intervention has been chosen, careful preoperative planning is necessary. The level, anatomic location, and morphology of the herniation must be precisely determined to select the optimal approach. Posterior laminectomy has largely been abandoned for the treatment of symptomatic thoracic disk protrusions. Surgeons still may choose among anterior, lateral, and posterior approaches when surgically addressing the thoracic intervertebral disk.