There are 12 vertebrae in the thoracic region. The spinal canal in the thoracic region is relatively small, however, the spinal cord could be easily compressed or injured in this area. Pain in the thoracic region can occur from cardiovascular origin, tumors, infection, compression fractures, and mediastinal structures. A point of consideration is thoracic disc herniation. It occurs more in the lower thoracic region, usually during the fifth decade of life. This disc herniation causes pain to radiate to the ribs and anteriorly at the same level. A thoracic disc herniation is uncommon and most are asymptomatic.
Clinically, a thoracic disc herniation will present itself as a radicular pain, anteriorly towards the rib (nerve root irritation).Myelopathy can occur from spinal cord compression. The patient could have a gait disturbance, leg weakness, as well as bladder and bowel dysfunction. Myelopathic findings are usually subtle. The physician should look for upper motor neuron signs such as hyperreflexia, clonus, and Babinski. A diagnosis is usually determined with magnetic resonance imaging (MRI). MRIs will help in ruling out the presence of fractures, tumors, or infections. Although an MRI is the study of choice, it has a high false positive rate. Asymptomatic patients may show a thoracic disc abnormality in their MRI.
Conservative treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. Surgery is indicated when the patient has pain that is not responding to conservative treatment for 6 months or if the patient has a thoracic disc herniation with myelopathy. Most surgeries are performed with an anterior approach with or without fusion. Fusion is done for spine instability and significant chronic pain. A laminectomy is contraindicated.