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Multiple thoracic disc herniation: an overlooked cause of back problems

The condition should be included in the differential diagnosis of spine disorders.

Issue: Issue 5 2005

ByKatsuji Shimizu, MD, DMSc

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Surgeons are less likely to cite thoracic disc herniation as a primary cause of back problems, compared to cervical or lumbar lesions. The diagnosis of a thoracic disc herniation can be difficult because there is no characteristic pattern of the onset of symptoms.

The recent popularization of MRI as a diagnostic tool in Japan and a greater awareness of thoracic spinal diseases have made it possible to diagnose thoracic disc herniations more easily and more accurately.

Multiple thoracic disc herniation, however, is a rarer condition, and there are few reports in the medical literature on treating the condition. But scientists recently reported that the incidence of multiple thoracic disc herniation may be more common than once thought.

From December 1998 to June 2002, we surgically treated 12 patients with multiple thoracic disc herniations at Gifu University Hospital.

The mean patient age was 63.0 years (range, 47 to 75 years) and the mean length of time between the onset of symptoms and the diagnosis was 46.9 months (range, eight days to 120 months). A mean of three disc herniations compressed the spinal cord at different levels, ranging from T3-4 to T12-L1. The most commonly affected levels were T7-8 and T9-10 (six patients).

Herniation challenges

Compared with single-level thoracic disc herniations, multiple herniations are resistant to conservative treatment. We treated all 12 cases surgically by anterior decompression and fusion using a transthoracic approach.

Our results indicate that anterior decompression and fusion for multiple thoracic disc herniations using a transthoracic approach can provide satisfactory results.

The clinical impact of this condition is that surgeons who are unaware of thoracic lesions and perform a lumbar laminectomy based on more popular diagnoses (particularly lumbar spinal canal stenosis) — which coincides in most of the cases — can cause paraplegia.

Neurological deterioration may also occur after lumbar decompression surgery in the presence of missed compressive lesions in the cervical or thoracic levels.

Greater awareness

Awareness of the possibility of single or multiple thoracic disc herniations, in combination with physical and radiological assessments, could enable surgeons to recognize the problem sooner and improve the outcome of treatment.

Multiple thoracic disc herniation must be included in the differential diagnosis of back problems.

Katsuji Shimizu, MD, DMSc, is a professor of orthopaedic surgery at Gifu University School of Medicine in Gifu, Japan, and is chairman of the Orthopaedics Today Editorial Advisory Board for 2005.

For more information:

• Ohnishi K, Miyamoto K, Kanamori Y, et al. Anterior decompression and fusion for multiple thoracic disc herniation. J Bone Joint Surg (Br). 87-B:356-360, 2005.
• Takeuchi A, Miyamoto K, Hosoe H, Shimizu K. Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery. J Neurosurg (Spine 1). 100:71-74, 2004.