Mid-Back (Thoracic)
Thoracic Disc Herniation
흉추 추간판 탈출증
Rare condition where thoracic disc compresses spinal cord or nerve root
- How common
- Rare (1% of all disc herniations)
- Typical age
- Ages 40–60
What is it?
Thoracic nucleus pulposus herniates posteriorly compressing cord or root. The narrow thoracic canal predisposes to myelopathy.
Commonly affected: T8-T12 most common (thoracolumbar junction)
How it develops
- Disc DegenerationDehydration and annular fissuring
- Nucleus HerniationTypically centrolateral protrusion
- Cord/Root CompressionNarrow canal raises myelopathy risk
- Band-like PainRadiating dermatomal chest pain
Symptoms
- Bowel/bladder dysfunctionEmergency sign of severe cord compression
- Mid-back painPain between shoulder blades or at thoracolumbar junction
- Band-like radicular painRadiates along dermatome around torso to anterior chest
- Lower limb weaknessProgressive leg weakness with cord compression
- Gait disturbanceUnsteady gait, balance impairment
How it is examined
- Dermatomal sensory lossT4 nipple line, T10 umbilical line sensory loss
- Lower limb hyperreflexiaExaggerated patellar/Achilles reflexes
- Babinski sign (+)Upgoing plantar reflex — UMN sign
- Beevor's signUmbilicus deviates with abdominal contraction — suggests T10+ lesion
Imaging
Plain X-ray often unremarkable; CT evaluates disc calcification.
- Possible disc space narrowing
- Disc calcification (30–70%)
- Coexistent spondylosis
MRI is modality of choice — shows herniation, cord compression, myelopathy signal change.
- Posterior disc protrusion
- Cord compression/deformation
- T2 cord signal change (myelopathy)
Non-surgical care
- Relative rest/postureAvoid prolonged slumping; activity modification
- NSAIDs + muscle relaxantsShort-term inflammation/spasm control
- Physical therapyThoracic mobilization, posture correction, core stabilization
- Selective nerve root blockImage-guided selective nerve root injection
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Progressive deficit, myelopathy, conservative failure
Procedures that may be discussed
- Transthoracic discectomy
- Costotransversectomy
- Thoracoscopic (VATS) discectomy
Outlook
60–80% improve with conservative care; surgery indicated if myelopathy present.