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Thoracic disk disease: diagnosis and treatment
J S Vanichkachorn1, A R Vaccaro
1Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Summary
Symptomatic thoracic degenerative disk disease is rare but requires imaging for diagnosis. Most cases resolve with nonoperative care, while surgery is reserved for severe, progressive neurological deficits.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Imaging
Background:
- Symptomatic degenerative disk disease is infrequent in the thoracic spine compared to cervical and lumbar regions.
- Diagnosis necessitates high clinical suspicion, supported by advanced imaging techniques.
- Presenting symptoms range widely, including pain and myelopathy.
Purpose of the Study:
- To review the diagnostic modalities and management strategies for symptomatic thoracic degenerative disk disease.
- To highlight the increasing incidental detection of thoracic disk abnormalities due to improved imaging resolution.
Main Methods:
- Review of current literature on thoracic degenerative disk disease diagnosis and treatment.
- Discussion of advanced imaging techniques: computed tomography (CT), myelography, and magnetic resonance imaging (MRI).
- Analysis of nonoperative and operative management approaches.
Main Results:
- Advanced imaging (CT, myelography, MRI) enhances visualization and diagnosis of thoracic spine disorders.
- Asymptomatic thoracic disk abnormalities are increasingly found incidentally.
- Nonoperative management is effective for most symptomatic patients.
Conclusions:
- Surgical intervention is typically reserved for acute thoracic disk herniations with progressive neurological deficits.
- Precise preoperative planning, including level, location, and morphology, is crucial for surgical success.
- Surgical approaches include anterior, lateral, and posterior techniques, with posterior laminectomy largely abandoned.