The spinal column has different names for different sections. At the top is the cervical, which includes vertebrae one through seven. Then comes the thoracic, which includes the next 12 vertebrae. Then comes the lumbar, then the sacral and finally the coccyx.

Disc herniation generally occurs in the cervical or lumbar sections of the spine. But herniations in the mid back, in the thoracic section, can happen, and they are hard to diagnose. Thoracic disc herniation is relatively rare, but can easily be missed by diagnosing physicians, or it can be misdiagnosed as something else, as it shares symptoms with other problems.

Part of the reason this kind of herniation is hard to diagnose is because symptoms are varied and can be confused as symptoms of another ailment. Depending on how the disc herniates in the thoracic vertebrae (into the spinal cord, into a nerve, etc.), different symptoms can occur. For some, a thoracic herniation leads to radiating pain in the chest and abdomen. Others have symptoms of numbness in their lower body. Others can lose control of their bowels or bladders (myelopathy).

Most cases of thoracic disc herniation heal on their own. Conservative treatment works well for some patients with this problem, while others require surgical intervention. But as of 2015, there is not universally accepted surgical treatment for symptomatic thoracic disc herniation.

A minimally invasive approach

Minimally invasive spine surgery (MISS) is quickly becoming the best option for many cases of lumbar and cervical herniation. Because of the success of MISS in these procedures, physicians have begun to explore the possibility of using MISS for thoracic disc herniation as well. The results so far are positive.

Researchers in China have formulated a minimally invasive technique for treating thoracic disc herniation. They use a combination of discectomy and foraminotomy. The discectomy in their procedure is performed with radiofrequency and a laser. Flouroscopic guidance was used to guide the procedure. After years of research using their procedure, these researchers concluded that it was a safe and effective way to treat thoracic disc herniation in select patients.

As respect for and use of minimally invasive spine surgery grows, thoracic disc herniation may eventually be regularly treated with MISS.

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Scott Adelman

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