The vast majority of symptomatic thoracic disc herniations can be treated without surgery. There are a variety of non-surgical treatment options that can be tried, and often patients will need to try several, or a combination of different treatments, to find what works best for them.
Non-surgical treatment options for upper back pain and other symptoms from a thoracic herniated disc will typically include one or a combination of the following:
The patient’s activity levels should be progressed gradually over a 6 to 12 week period as symptoms improve. In the vast majority of cases, the natural history of thoracic disc herniation is one of improvement with one or a combination of the above conservative (non-operative) treatments.
Operative intervention for a thoracic herniated disc is indicated in only rare instances when a herniated disc leads to myelopathy (spinal cord dysfunction), progressive neurologic deficits, or intolerable pain. Typically, these symptoms occur following an acute traumatic disc herniation with myelopathy. The surgery to address these symptoms, called a decompression, is designed to take the pressure off the spinal cord or nerve root.
Historically, the surgical approach for a decompression was performed via a posterior approach through a laminectomy. Outcomes were poor in large part because retraction on the spinal cord is not well tolerated and most thoracic disc herniations have a central component that cannot be reached without spinal cord retraction. More recently, one of the following surgical approaches will be used:
Operative treatment is reserved for cases of myelopathy, progressive lower extremity weakness, and intolerable radicular pain that does not get better with non-operative treatments.
In cases where surgery was indicated, Bohlman and Zdeblick evaluated 19 patients treated with either costotransversectomy or trans-thoracic decompression of a thoracic disc herniation. There were 16 patients with good or excellent outcomes and 3 patients with fair or poor results. Two poor outcomes were in the costotransversectomy group leading to their opinion that the trans-thoracic approach should be the preferred approach2.
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In a separate study, Reagan, BinYashay, and Mack reported 76% satisfactory results in 29 patients who underwent a Video Assisted Thoracic Surgery procedure3, the minimally invasive trans-thoracic approach to the thoracic disc space.
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