Thoracic Disc Herniation

Consensus in the literature supports surgery for severely symptomatic or disabling thoracic disc herniation only, with all others requiring observation or non-surgical intervention. For those patients requiring surgery, there are a variety of approaches that are used depending on symptomatology, spinal level, disc size, disc location relative to the canal and to the neural elements, presence of calcification, and overall health status of the patient. Dorsolateral/lateral approaches include transpedicular, transfacet pedicle-sparing, costotransversectomy, extracavitary, and parascapular; ventrolateral approaches include transthoracic thoracotomy, transthoracic thoracoscopy, and retropleural thoracotomy; finally, ventral approaches include transsternal and manubrial window. Thoracic myelopathy has a broad differential diagnosis. The cause of which can be identified with a detailed history, physical exam, and properly selected imaging. In the following chapter, we discuss herniated thoracic discs (HTD) including the common presentations, imaging findings, and the surgical treatment options. Consensus in the literature supports surgical management for HTDs that are severely symptomatic and disabling. The surgical approaches depends on the spine level, disc size, disc location, presence of calcification, and overall health status of the patient. The improvement rate for myelopathic patients ranges from 71% to 97% and for back pain and radicular pain from 67% to 94%. The overall complication rate is approximately 15%.