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Spine
Diagnosis
Degenerative Diseases and Arthritides
Degenerative Diseases
Thoracic Intervertebral Disc Herniation
Thoracic Intervertebral Disc Herniation
Jeffrey S. Ross, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Thoracic disc herniation (TDH)

          • Synonyms

            • Protruded disc, extruded disc, free fragment, sequestered disc
            • Nonstandard: Prolapse, herniated nucleus pulposus (HNP), rupture
            • Dorsal spinal disc herniation

          • Definitions

            • Localized (< 50% of disc circumference) displacement of disc material beyond edges of vertebral ring apophyses

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Nonvascular Interventions

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Dützmann S et al: Revision surgery in thoracic disc herniation. Eur Spine J. 29(Suppl 1):39-46, 2020
                                        2. Court C et al: Thoracic disc herniation: surgical treatment. Orthop Traumatol Surg Res. 104(1S):S31-40, 2018
                                        3. Gong M et al: Surgery for giant calcified herniated thoracic discs: a systematic review. World Neurosurg. 118:109-17, 2018
                                        4. Snyder LA et al: Minimally invasive treatment of thoracic disc herniations. Neurosurg Clin N Am. 25(2):271-7, 2014
                                        5. Yoshihara H: Surgical treatment for thoracic disc herniation: an update. Spine (Phila Pa 1976). 39(6):E406-12, 2014
                                        6. Oppenlander ME et al: Surgical management and clinical outcomes of multiple-level symptomatic herniated thoracic discs. J Neurosurg Spine. 19(6):774-83, 2013
                                        7. Deviren V et al: Minimal invasive anterolateral transthoracic transpleural approach: a novel technique for thoracic disc herniation. A review of the literature, description of a new surgical technique and experience with first 12 consecutive patients. J Spinal Disord Tech. 24(5):E40-8, 2011
                                        8. Sheikh H et al: Techniques for the operative management of thoracic disc herniation: minimally invasive thoracic microdiscectomy. Orthop Clin North Am. 38(3):351-61; abstract vi, 2007
                                        9. Fessler RG et al: The development of minimally invasive spine surgery. Neurosurg Clin N Am. 17(4):401-9, 2006
                                        10. Perez-Cruet MJ et al: Thoracic microendoscopic discectomy. J Neurosurg Spine. 1(1):58-63, 2004
                                        11. Burke TG et al: Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique. Neurosurg Focus. 9(4):e9, 2000
                                        12. Vollmer DG et al: Transthoracic approaches to thoracic disc herniations. Neurosurg Focus. 9(4):e8, 2000
                                        13. Dickman CA et al: Reoperation for herniated thoracic discs. J Neurosurg. 91(2 Suppl): 157-62, 1999
                                        14. Levi N et al: Thoracic disc herniation. Unilateral transpedicular approach in 35 consecutive patients. J Neurosurg Sci. 43(1): 37-42; discussion 42-3, 1999
                                        15. Stillerman CB et al: Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg. 88(4): 623-33, 1998
                                        16. Korovessis PG et al: Three-level thoracic disc herniation: case report and review of the literature. Eur Spine J. 6(1): 74-6, 1997
                                        17. Wood KB et al: The natural history of asymptomatic thoracic disc herniations. Spine. 22(5): 525-9; discussion 529-30, 1997
                                        18. Whitcomb DC et al: Chronic abdominal pain caused by thoracic disc herniation. Am J Gastroenterol. 90(5): 835-7, 1995
                                        19. Wood KB et al: Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg Am. 77(11): 1631-8, 1995
                                        20. Boukobza M et al: Thoracic disc herniation and spinal cord compression. MRI and gadolinium-enhancement. J Neuroradiol. 20(4): 272-9, 1993
                                        21. Dietze DD Jr et al: Thoracic disc herniations. Neurosurg Clin N Am. 4(1): 75-90, 1993
                                        22. Brown CW et al: The natural history of thoracic disc herniation. Spine. 17(6 Suppl): S97-102, 1992
                                        23. Parizel PM et al: Gd-DTPA-enhanced MR in thoracic disc herniations. Neuroradiology. 31(1):75-9, 1989
                                        24. Blumenkopf B: Thoracic intervertebral disc herniations: diagnostic value of magnetic resonance imaging. Neurosurgery. 23(1): 36-40, 1988
                                        25. Ross JS et al: Thoracic disk herniation: MR imaging. Radiology. 165(2): 511-5, 1987
                                        26. Benson MK et al: The clinical syndromes and surgical treatment of thoracic intervertebral disc prolapse. J Bone Joint Surg Br. 57(4): 471-7, 1975
                                        27. Carson J et al: Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry. 34(1): 68-77, 1971
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Thoracic disc herniation (TDH)

                                                • Synonyms

                                                  • Protruded disc, extruded disc, free fragment, sequestered disc
                                                  • Nonstandard: Prolapse, herniated nucleus pulposus (HNP), rupture
                                                  • Dorsal spinal disc herniation

                                                • Definitions

                                                  • Localized (< 50% of disc circumference) displacement of disc material beyond edges of vertebral ring apophyses

                                                IMAGING

                                                • General Features

                                                  • CT Findings

                                                    • MR Findings

                                                      • Nonvascular Interventions

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Dützmann S et al: Revision surgery in thoracic disc herniation. Eur Spine J. 29(Suppl 1):39-46, 2020
                                                                              2. Court C et al: Thoracic disc herniation: surgical treatment. Orthop Traumatol Surg Res. 104(1S):S31-40, 2018
                                                                              3. Gong M et al: Surgery for giant calcified herniated thoracic discs: a systematic review. World Neurosurg. 118:109-17, 2018
                                                                              4. Snyder LA et al: Minimally invasive treatment of thoracic disc herniations. Neurosurg Clin N Am. 25(2):271-7, 2014
                                                                              5. Yoshihara H: Surgical treatment for thoracic disc herniation: an update. Spine (Phila Pa 1976). 39(6):E406-12, 2014
                                                                              6. Oppenlander ME et al: Surgical management and clinical outcomes of multiple-level symptomatic herniated thoracic discs. J Neurosurg Spine. 19(6):774-83, 2013
                                                                              7. Deviren V et al: Minimal invasive anterolateral transthoracic transpleural approach: a novel technique for thoracic disc herniation. A review of the literature, description of a new surgical technique and experience with first 12 consecutive patients. J Spinal Disord Tech. 24(5):E40-8, 2011
                                                                              8. Sheikh H et al: Techniques for the operative management of thoracic disc herniation: minimally invasive thoracic microdiscectomy. Orthop Clin North Am. 38(3):351-61; abstract vi, 2007
                                                                              9. Fessler RG et al: The development of minimally invasive spine surgery. Neurosurg Clin N Am. 17(4):401-9, 2006
                                                                              10. Perez-Cruet MJ et al: Thoracic microendoscopic discectomy. J Neurosurg Spine. 1(1):58-63, 2004
                                                                              11. Burke TG et al: Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique. Neurosurg Focus. 9(4):e9, 2000
                                                                              12. Vollmer DG et al: Transthoracic approaches to thoracic disc herniations. Neurosurg Focus. 9(4):e8, 2000
                                                                              13. Dickman CA et al: Reoperation for herniated thoracic discs. J Neurosurg. 91(2 Suppl): 157-62, 1999
                                                                              14. Levi N et al: Thoracic disc herniation. Unilateral transpedicular approach in 35 consecutive patients. J Neurosurg Sci. 43(1): 37-42; discussion 42-3, 1999
                                                                              15. Stillerman CB et al: Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg. 88(4): 623-33, 1998
                                                                              16. Korovessis PG et al: Three-level thoracic disc herniation: case report and review of the literature. Eur Spine J. 6(1): 74-6, 1997
                                                                              17. Wood KB et al: The natural history of asymptomatic thoracic disc herniations. Spine. 22(5): 525-9; discussion 529-30, 1997
                                                                              18. Whitcomb DC et al: Chronic abdominal pain caused by thoracic disc herniation. Am J Gastroenterol. 90(5): 835-7, 1995
                                                                              19. Wood KB et al: Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg Am. 77(11): 1631-8, 1995
                                                                              20. Boukobza M et al: Thoracic disc herniation and spinal cord compression. MRI and gadolinium-enhancement. J Neuroradiol. 20(4): 272-9, 1993
                                                                              21. Dietze DD Jr et al: Thoracic disc herniations. Neurosurg Clin N Am. 4(1): 75-90, 1993
                                                                              22. Brown CW et al: The natural history of thoracic disc herniation. Spine. 17(6 Suppl): S97-102, 1992
                                                                              23. Parizel PM et al: Gd-DTPA-enhanced MR in thoracic disc herniations. Neuroradiology. 31(1):75-9, 1989
                                                                              24. Blumenkopf B: Thoracic intervertebral disc herniations: diagnostic value of magnetic resonance imaging. Neurosurgery. 23(1): 36-40, 1988
                                                                              25. Ross JS et al: Thoracic disk herniation: MR imaging. Radiology. 165(2): 511-5, 1987
                                                                              26. Benson MK et al: The clinical syndromes and surgical treatment of thoracic intervertebral disc prolapse. J Bone Joint Surg Br. 57(4): 471-7, 1975
                                                                              27. Carson J et al: Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry. 34(1): 68-77, 1971