Thoracic Disc Injuries
- Author: Kambiz Hannani, MD; Chief Editor: Sherwin SW Ho, MD more...
Thoracic disc injury, first described in 1838, is an uncommon site of injury owing to the stabilizing effect of the rib cage. The similarity of symptoms to lumbar disc herniation makes the diagnosis of a thoracic disc injury difficult,[2, 3, 4, 5, 6] but the process tends to be self-limiting and rarely requires surgical intervention.
(See also the articles Disk Herniation and Thoracic Spine, Trauma [in the Radiology section], Thoracic Discogenic Pain Syndrome [in the Sports Medicine section], Lumbar Disc Disease [in the Neurosurgery section], and Herniated Nucleus Pulposus [in the Orthopedic Surgery section], as well as Return to Contact Sports After Spinal Surgery and Thoracoscopic Spine Surgery for Decompression and Stabilization of the Anterolateral Thoracic and Lumbar Spine on Medscape.)
The incidence of thoracic disc injuries is 1 in 1 million persons per year, and these injuries account for 0.25-0.75% of all disc herniations.
The thoracic discs are unusually stable compared with the cervical and lumbar discs. The stability of the thoracic discs is secondary to the surrounding rib cage, with the stabilizing effect of the rib articulations. However, the blood supply of the thoracic spine is more tenuous than the cervical and lumbar spine, especially at the T4-T9 watershed area, which is more prone to ischemic injury.
The facet orientation in the thoracic spine is vertical, with a slight medial angulation. This orientation allows for easier lateral bending and rotation versus pure bending. Biomechanical studies have shown that intervertebral discs are at the highest risk of injury when combined with bending and torsional forces. Therefore, the thoracic spine discs are at a decreased risk of injury because of the decreased bending potential in this segment of the spine.
The spinal cord-to-canal ratio (the ratio of the cross-sectional area of the cord to the cross-sectional area of the spinal canal) is 40% in the thoracic spine versus 25% in the cervical spine. The thoracic spine is also naturally kyphotic. These 2 facts make the thoracic spine more sensitive to cord compression from disc herniation.
Peker S, Akkurt C, Ozcan OE. Multiple thoracic disc herniations. Acta Neurochir (Wien). 1990. 107(3-4):167-70. [Medline].
Aizawa T, Sato T, Tanaka Y, et al. Thoracic myelopathy in Japan: epidemiological retrospective study in Miyagi Prefecture during 15 years. Tohoku J Exp Med. 2006 Nov. 210(3):199-208. [Medline]. [Full Text].
Linscott MS, Heyborne R. Thoracic intervertebral disk herniation: a commonly missed diagnosis. J Emerg Med. 2007 Apr. 32(3):235-8. [Medline].
Vanichkachorn JS, Vaccaro AR. Thoracic disk disease: diagnosis and treatment. J Am Acad Orthop Surg. 2000 May-Jun. 8(3):159-69. [Medline].
Hidalgo-Ovejero AM. Thoracic disc herniation mimicking acute lumbar disease. Spine. 1999 Oct 1. 24(19):2066-7. [Medline].
Oppenheim JS, Rothman AS, Sachdev VP. Thoracic herniated discs: review of the literature and 12 cases. Mt Sinai J Med. 1993 Sep. 60(4):321-6. [Medline].
Arce CA, Dohrmann GJ. Herniated thoracic disks. Neurol Clin. 1985 May. 3(2):383-92. [Medline].
Ghanem N, Uhl M, Müller C, et al. MRI and discography in traumatic intervertebral disc lesions. Eur Radiol. 2006 Nov. 16(11):2533-41. [Medline].
Gorman WF, Hodak JA. Herniated intervertebral disc without pain. J Okla State Med Assoc. 1997 May-Jun. 90(5):185-90. [Medline].
Dietze DD Jr, Fessler RG. Thoracic disc herniations. Neurosurg Clin N Am. 1993 Jan. 4(1):75-90. [Medline].
Cornips E, Beuls E, Geskes G, et al. Preoperative localization of herniated thoracic discs using myelo-CT guided transpleural puncture: technical note. Childs Nerv Syst. 2007 Jan. 23(1):21-6. [Medline].
Post NH, Cooper PR, Frempong-Boadu AK, Costa ME. Unique features of herniated discs at the cervicothoracic junction: clinical presentation, imaging, operative management, and outcome after anterior decompressive operation in 10 patients. Neurosurgery. 2006 Mar. 58(3):497-501; discussion 497-501. [Medline].
Ohnishi K, Miyamoto K, Kanamori Y, et al. Anterior decompression and fusion for multiple thoracic disc herniation. J Bone Joint Surg Br. 2005 Mar. 87(3):356-60. [Medline].
Turgut M. Spinal cord compression due to multilevel thoracic disc herniation: surgical decompression using a "combined" approach. A case report and review of the literature. J Neurosurg Sci. 2000 Mar. 44(1):53-9. [Medline].
Willardson JM. Core stability training: applications to sports conditioning programs. J Strength Cond Res. 2007 Aug. 21(3):979-85. [Medline].
Almond LM, Hamid NA, Wasserberg J. Thoracic intradural disc herniation. Br J Neurosurg. 2007 Feb. 21(1):32-4. [Medline].
Bartels RH, Peul WC. Mini-thoracotomy or thoracoscopic treatment for medially located thoracic herniated disc?. Spine. 2007 Sep 15. 32(20):E581-4. [Medline].
Eichholz KM, O'Toole JE, Fessler RG. Thoracic microendoscopic discectomy. Neurosurg Clin N Am. 2006 Oct. 17(4):441-6. [Medline].
Gille O, Razafimahandry HJ, Söderlund C, Gangnet N, Vital JM. [T1-T2 disc herniation: two cases] [French]. Rev Chir Orthop Reparatrice Appar Mot. 2006 Nov. 92(7):715-8. [Medline].
Gille O, Soderlund C, Razafimahandri HJ, Mangione P, Vital JM. Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy. Eur Spine J. 2006 May. 15(5):537-42. [Medline].
Isaacs RE, Podichetty VK, Sandhu FA, et al. Thoracic microendoscopic discectomy: a human cadaver study. Spine. 2005 May 15. 30(10):1226-31. [Medline].
Korovessis PG, Stamatakis M, Michael A, Baikousis A. Three-level thoracic disc herniation: case report and review of the literature. Eur Spine J. 1997. 6(1):74-6. [Medline].
Lidar Z, Lifshutz J, Bhattacharjee S, Kurpad SN, Maiman DJ. Minimally invasive, extracavitary approach for thoracic disc herniation: technical report and preliminary results. Spine J. 2006 Mar-Apr. 6(2):157-63. [Medline].
Nakahara S, Sato T. First thoracic disc herniation with myelopathy. Eur Spine J. 1995. 4(6):366-7. [Medline].
Perez-Cruet MJ, Kim BS, Sandhu F, Samartzis D, Fessler RG. Thoracic microendoscopic discectomy. J Neurosurg Spine. 2004 Jul. 1(1):58-63. [Medline].
Rohde RS, Kang JD. Thoracic disc herniation presenting with chronic nausea and abdominal pain. A case report. J Bone Joint Surg Am. 2004 Feb. 86-A(2):379-81. [Medline].
Sagiuchi T, Iida H, Tachibana S, et al. Idiopathic spinal cord herniation associated with calcified thoracic disc extrusion--case report. Neurol Med Chir (Tokyo). 2003 Jul. 43(7):364-8. [Medline]. [Full Text].
Sasai K, Adachi T, Togano K, et al. Two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis in the lower extremities without clinical symptoms or signs in the upper extremities. Spine J. 2006 Jul-Aug. 6(4):464-7. [Medline].
Sheikh H, Samartzis D, Perez-Cruet MJ. Techniques for the operative management of thoracic disc herniation: minimally invasive thoracic microdiscectomy. Orthop Clin North Am. 2007 Jul. 38(3):351-61; abstract vi. [Medline].
Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg. 1998 Apr. 88(4):623-33. [Medline].
Vazquez D, Solano I, Pages E, Garcia L, Serra J. Thoracic disc herniation, cord compression, and paraplegia caused by electrical injury: case report and review of the literature. J Trauma. 1994 Aug. 37(2):328-32. [Medline].
Wilke A, Wolf U, Lageard P, Griss P. Thoracic disc herniation: a diagnostic challenge. Man Ther. 2000 Aug. 5(3):181-4. [Medline].