What it is
The thoracic spine spans from the base of the neck to the start of the lumbar spine — twelve vertebrae, each articulating with a pair of ribs. Disc herniations in this region are far less common than in the cervical or lumbar spine, partly because the rib cage provides a degree of structural support that limits motion and mechanical stress on thoracic discs.
When thoracic disc herniations do occur, they tend to present differently depending on location and size:
- Lateral herniations compress nerve roots and produce radicular pain that wraps around the chest wall (thoracic radiculopathy). This can mimic cardiac or gastrointestinal pain and is often initially misdiagnosed.
- Central herniations compress the spinal cord itself and can cause myelopathy — lower extremity weakness, gait disturbance, bowel or bladder dysfunction — with the potential for permanent neurological injury if not addressed.
Calcified discs
A significant proportion of thoracic disc herniations become calcified — hardened — which makes surgical treatment more technically demanding. The proximity of the spinal cord means that even a small surgical miscalculation can cause injury, and the surgical approach must be carefully planned.
Surgical considerations
Surgery is not required for radicular pain from a thoracic herniation if symptoms are tolerable and not worsening. It becomes necessary when myelopathy is present or when radicular symptoms are severe and refractory.
The approach — lateral (costotransversectomy, lateral extracavitary), anterior (thoracotomy or thoracoscopic), or posterior — depends on the location, calcification, and extent of herniation. Thoracic disc surgery carries higher complexity than lumbar disc surgery and should be performed by surgeons experienced with thoracic pathology.